A patient on chemotherapy with fever and a neutrophil count below 0.5 × 10⁹/L, or expected to fall below it, should receive empirical broad-spectrum antibiotics within an hour of arrival. Do not wait for the blood count if the history fits; take blood cultures and start treatment in parallel.
Risk tools such as the MASCC score help identify patients who may be suitable for oral or outpatient management, but only after the first dose has been given and the patient assessed. Give every patient on myelosuppressive treatment written instructions and a number to call with a temperature.
- Give empirical antibiotics within one hour for suspected febrile neutropenia.
- Take blood cultures, but do not delay antibiotics for results or the full blood count.
- Use a validated risk score to select low-risk patients for oral or outpatient care.
- Give patients on chemotherapy a written fever plan and contact number.
Why it matters
Delay to the first antibiotic dose is one of the few modifiable drivers of mortality in neutropenic sepsis.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for oncology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free