Antipseudomonal b-lactams, a fourth-generation cephalosporin, or a carbapenem are options for empiric therapy for pediatric high-risk febrile neutropenia.
The choice of agent will depend on local susceptibility patterns and a second agent directed at gram negatives (such as an aminoglycoside) may used in some centers. All of these regimens provide a broad gram negative including pseudomonas coverage. Piperacillin/tazobactam or a carbapenem would provide anerobic coverage while cefepime would not.
Additional gram negative coverage and/or Vancomycin may be needed in some higher risk patients and those who are clinically ill.
References:
Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, Carlesse F, Groll AH, Haeusler GM, Santolaya M, Steinbach WJ, Castagnola E, Davis BL, Dupuis LL, Gaur AH, Tissing WJE, Zaoutis T, Phillips R, Sung L. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol. 2017 Jun 20;35(18):2082-2094. PMID: 28459614.