# Leukopenia and Neutropenia Referral - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · BSH Guideline on the Management of Neutropenia 2019 - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - BSH Guideline on the Management of Neutropenia 2019 ## Treatment metadata - Amoxicillin + clavulanic acid — 1000 mg — oral.solid ## Complete treatment card ```text LEUKOPENIA AND NEUTROPENIA REFERRAL Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · BSH Guideline on the Management of Neutropenia 2019 Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - A history of frequent infections is common in neutropenia [recurrent infections] - Past infections with unusual bacteria or fungi raise suspicion for neutropenia - A history of opportunistic infections is often reported - Frequent past courses of antibiotics or antifungals support the diagnosis - Fatigue, malaise, bone pain, night sweats, or unexplained weight loss can point to an underlying cancer [bone pain · fatigue · malaise · night sweats · weight loss] SIGNS - what you find (12) - An enlarged liver and spleen, or signs of thyroid or connective tissue disease, can point to an autoimmune cause [hepatomegaly] - Joint pain, skin rash, and Raynaud phenomenon suggest an underlying connective tissue disorder [joint pain · rash] - Warts are a characteristic finding of WHIM syndrome - Eczema is a hallmark of Wiskott-Aldrich syndrome - Albinism-type skin and eye pigment changes suggest Chediak-Higashi syndrome - Delayed separation of the umbilical cord points to alloimmune neutropenia - Coarse facial features can be a clue to an underlying syndromic cause - Recurrent oral thrush (mucocutaneous candidiasis) can be a feature - Lung abscesses and air-filled lung cysts (pneumatoceles) reflect chronic pulmonary infection [cyst] - Poor wound healing can be a feature of neutropenic disorders - Recurrent tonsillitis, sore throat, mouth ulcers, and middle ear infections are common infectious presentations [mouth ulcers · sore throat] - Malabsorption in infancy, with a normal sweat chloride test, points to Schwachman-Diamond syndrome rather than cystic fibrosis TESTS (12) - Quantitative immunoglobulins (IgG, IgM, IgA, IgE) can be checked; raised IgG and IgM may suggest an autoimmune cause - Low B-cell counts and low gammaglobulin levels are seen in disorders like WHIM syndrome - The nitroblue tetrazolium test checks NADPH oxidase activity and stays negative in chronic granulomatous disease - A positive ANA strongly suggests an autoimmune process - Neonates should be tested for maternal IgG antibodies against fetal neutrophils - Complement levels (C3, C4) and total complement activity (CH50) can be checked since autoimmune neutropenia often activates complement - Blood, urine, stool, sputum, and CSF cultures screen for a source of infection - A full blood count gives the absolute neutrophil count - Iron, copper, B12, and folate levels should be checked for a nutritional cause - HIV and hepatitis B/C should be checked as infectious causes - A blood film can rule out a spuriously low count from cold-agglutinin clumping - Bone marrow biopsy distinguishes a low marrow reserve from a normal-reserve cause and is typically normal in autoimmune neutropenia IF NOT THIS - what else fits (2) - Antibody deficiency disorders cause low immunoglobulin classes and also bring recurrent bacterial or fungal, sometimes opportunistic, infections - Complement deficiencies such as C3 deficiency cause recurrent extracellular bacterial infections plus neutropenia, but complement testing separates the two Source StatPearls "Neutropenia" - disease-level clinical article Status traced to the source above 1. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 1 g (875/125 mg) twice daily - Until urgent hospital specialist evaluation Peds Pediatric febrile neutropenia requires IMMEDIATE hospital admission for IV antibiotics; do not manage outpatient Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph): "Immediate release: 500 mg every 8 to 12 hours or 875 mg every 12 hours", 875/125 mg tablet. The febrile-neutropenia indication is from the BSH Guideline on the Management of Neutropenia 2019, which is not held in this corpus. Why Empirical broad-spectrum cover for mild outpatient febrile neutropenia while arranging emergency referral Caution FEBRILE NEUTROPENIA IS A MEDICAL EMERGENCY (Absolute Neutrophil Count ANC <0.5 x 10^9/L with fever >=38.0C): Transfer immediately to hospital for IV broad-spectrum antibiotics. Identify drug-induced neutropenia (carbimazole, co-trimoxazole, NSAIDs, psychotropics) and stop suspected offending agent. Non-febrile mild/moderate neutropenia requires routine haematology investigation. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)