Febrile Neutropenia 🌡️

• Oral temperature >38.3°C, OR two consecutive readings >38.0°C for 2 hours, PLUS ANC <0.5 × 10⁹/L (or expected to fall below 0.5).
• Treat promptly even if afebrile/low-grade if the patient is unwell or hypotensive - infection signs can be minimal (steroids, elderly).
• Nadir often 7–14 days after chemotherapy. In-hospital mortality ~10%.

• ABC + resuscitate. Use HSE sepsis pathway.
• IV antibiotics within 1 hour - do not wait for full labs.
• Blood cultures ×2 before antibiotics: peripheral + every indwelling line.
• Urgent FBC, U&E, LFTs, coag, CRP, lactate.
• Focused source exam (chest, abdomen/perineum, skin, mouth, CNS, line).
• Notify oncology/haematology immediately. Follow local antimicrobial policy.

• High risk (MASCC <21 or clinical concern): admit; continue broad-spectrum IV antibiotics (e.g. piperacillin–tazobactam / local FN regimen; aminoglycosides often used). Monitor for pre-shock.
• Low risk (MASCC ≥21): some stable patients may step to oral therapy (typically ciprofloxacin + co-amoxiclav) ± early discharge after ≥24 h if local protocol allows - exclude acute leukaemia, pneumonia, organ failure, severe soft-tissue infection; avoid oral quinolone if already on quinolone prophylaxis.
• Add cover for focus: glycopeptide for suspected line infection (do not remove a stable patient’s line without micro evidence); macrolide/quinolone if pneumonia; metronidazole if abdominal sepsis (unless already on pip-tazo/carbapenem).
• Optional: score disposition with the MASCC calculator at the bottom of this topic (≥21 = low risk).

• Daily until afebrile with ANC ≥0.5 × 10⁹/L for 24 h. Reassess every 2–4 h if needing resuscitation.
• Still febrile at 48 h but stable → continue same regimen. Deteriorating → broaden/rotate and call ID/microbiology.
• Fever >4–6 days → consider empirical antifungals ± chest/upper abdomen imaging (HRCT).
• Can usually stop antibacterials once ANC ≥0.5, asymptomatic, afebrile 48 h, and cultures negative - longer if still neutropenic or high-risk leukaemia (follow local protocol).

• Shock / SBP ≤90, new confusion, respiratory distress, severe abdominal pain, tunnel/pocket line infection, or deterioration on antibiotics.

Based on