When fever persists for 72 h or longer despite the initial empiric regimen, consideration should be given to changing therapy. A vigorous search for a fever source should be continued, including repeat exams, cultures, chest X-ray, and sometimes CT scans. If positive cultures have been obtained, the regimen can be adjusted accordingly but should retain broad-spectrum coverage, as the patient may still be neu-tropenic.
Changes in empiric therapy include (1) addition of a second agent to a monotherapy regimen; (2) changing one or more agents in the regimen, such as a car-bapenem in place of a beta-lactam; (3) addition of van-comycin; and (4) addition of systemic antifungal therapy (see below).
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