blood, urine, throat and other indicated cultures are 
performed. Initial empiric antibiotic coverage will 
consist of a third generation cephalosporin, with 
further additions or adjustments determined by the 
patient's clinical condition and culture results. .Once 
antibiotic treatment has been instituted, it should not 
be discontinued routinely until the absolute neutrophil 
count has recovered to > 500/mm3. 
4. Antifungal treatment will be considered in patients 
who have persistent fevers on broad spectrum 
antibiotics after 3-4 days, or positive fungal 
cultures, or abnormalities on CAT scan, MRI or plain 
films suggestive of fungal disease. Amphotericin will 
be initiated with a test dose of one mg, and if 
tolerated starting dose will be .5 mg/kg. This may be 
increased up to a dose of 1.0 mg/kg if fevers persist 
or fungal infection is documented. Doses will be 
adjusted to ref lect • renal function as necessary. 
5. All patients will receive trimethoprim- 
sulfamethoxazole prophylaxis beginning between day -4 
and day +3. Patients will receive one double strength 
tablet bid on Saturday and Sunday until day +90. If 
unable to tolerate p.o, patients will receive 5 mg/kg 
IV bid Saturday and Sunday (based on trimethoprim 
component) instead. 
if 
6. All HSV sero-positive patients will receive 
acyclovir beginning day -5. Dose will be 250mg/m 2 IV 
ql2 hours. Patients will switch to 200mg p.o. tid upon 
hospital discharge, and continue until day +90. 
6.4 Oral Hygiene, Management of Mucositis 
1. Nystatin oral suspension IX 10 6 units swish and 
swallow q4 hours, beginning day -4, d/c when ANC > 
1000/ul for 3 days. 
2. Peridex solution, swish and spit q4 hours, 
beginning day -4, d/c when ANC > 1000/ul for 3 days. 
3. Salt and soda solution, swish and spit q4 hours, 
beginning "day -4; :d/c when". : ANC > 1000/ul for three 
days . 
4. Chlotrimazole troches prn. 
5. Parenteral narcotics (including morphine sulfate 
continuous infusion or via PCA pump) if necessary for 
control of mucositis pain. 
'I 
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Recombinant DNA Research, Volume 16 
