CNS 18 - 14 
5.4 Supportive and Concurrent Care 
5.4.1 Fever and neutropenia 
In the event of the development of fever and neutropenia or significant 
bacterial infection (such as central line infection or ventriculoperitoneal 
shunt), antibiotic combination of first choice is vancomycin and 
ceftazidime. Nephrotoxic antibiotics or antifungal agents may increase the 
incidence of renal toxicity associated with GCV. Their use should be 
dictated by clinical circumstances including surveillance cultures and 
institutional infection patterns. Do not stop ganciclovir unless the criteria 
in Section 5.3.1 are present. 
5.4.2 Fever and chills with ganciclovir should be treated with acetaminophen 
every 4 hours at age appropriate dosages. 
5.4.3 Rashes should be treated with diphenhydramine 25 mg/m 2 q6 hours IV or 
po. 
5.4.4 Severe edema - as a precaution, all patients will be treated with decadron 
as noted in Section 5.2.2. 
5.4.5 All patients should be on trimethoprim-sulfamethoxazole prophylaxis (150 
mg/m 2 /day based on trimethoprim) Monday, Tuesday, Wednesday, po 
bid. 
5.4.6 Venous access must be adequate. A percutaneous intravenous catheter can 
be used if a central line or port-a-cath is not present. 
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