chronic

Leukopenia and Neutropenia Referral

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - Antimicrobial 2023 · BSH Guideline on the Management of Neutropenia 2019

Verified against2 documents

Egyptian National Drug Formulary - Antimicrobial 2023
BSH Guideline on the Management of Neutropenia 2019

Verified date2026-08

Presentation reference

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

SourceStatPearls "Neutropenia" - disease-level clinical article

Presentation findings are traced to the source above.

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g (875/125 mg) twice daily - Until urgent hospital specialist evaluation

Paediatric dose

Pediatric febrile neutropenia requires IMMEDIATE hospital admission for IV antibiotics; do not manage outpatient

Dose 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

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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 > NOVELL PHARMA	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 PHARMACEUTICAL > HIKMA PHARMA	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? strength differs? different route - not oral solid	MISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.	8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solid	CID	8.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.