treat fever in asplenic patients seriously

Asplenic patients are at increased risk of infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.  Overwhelming infection in asplenic patients is rare but rapidly fatal if not recognized and treated aggressively at an early stage.  On presentation, the patient may have mild symptoms and not appear toxic, but the infection can progress within hours to fulminant disease with severe shock, sepsis, and disseminated intravascular coagulation.

Consequently, any febrile illness in an asplenic patient should prompt aggressive antibiotic therapy, even if the patient appears relatively stable (Choices B and C).  Acceptable empiric oral regimens include amoxicillin-clavulanate, cefuroxime, or extended-spectrum fluoroquinolones (eg, levofloxacin).

(Choices A and D)  Treatment should continue for at least 72 hours while urgent diagnostic evaluation (eg, blood cultures, radiographs) is performed.  Patients with signs of severe illness should receive empiric broad-spectrum coverage such as combination vancomycin and ceftriaxone.