In a patient on chemotherapy with fever (a single temperature of 38.3 degrees Celsius, or 38.0 sustained) and neutropenia, start empirical broad-spectrum antibiotics within an hour of presentation, before culture results. Use an antipseudomonal beta-lactam as the backbone, adjusted to local resistance and the patient's allergies and risk.
Take blood cultures (including from any central line) and a focused septic screen first, but never let investigations delay the first dose. Risk-stratify afterwards for who may step down or complete treatment as an outpatient, but the initial move is fast, broad cover.
- Treat fever with neutropenia on chemotherapy as an emergency.
- Give empirical broad-spectrum antibiotics within one hour, before cultures return.
- Use an antipseudomonal beta-lactam backbone, adjusted to local resistance and allergy.
- Take cultures and a septic screen first, but do not let them delay the first dose.
Why it matters
Delay to first antibiotic in neutropenic sepsis costs lives, and the window is short.
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