Fever in a patient who has had chemotherapy in the past few weeks should be treated as neutropenic sepsis until proven otherwise. Do not wait for the neutrophil count before acting.
Take blood cultures and start broad-spectrum empirical antibiotics within an hour of arrival, following local protocol. Assess risk with a validated tool to decide who can be considered for outpatient management. Avoid rectal examination and rectal thermometers in suspected neutropenia.
- Treat fever after recent chemotherapy as neutropenic sepsis until proven otherwise
- Start empirical antibiotics within an hour; do not wait for the count
- Take blood cultures, including from any central line, before the first dose where this causes no delay
- Use a validated risk score to identify low-risk patients
- Avoid rectal examination in suspected neutropenia
Why it matters
Delay to the first antibiotic dose is one of the few modifiable drivers of death in neutropenic sepsis.
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