A patient within a few weeks of chemotherapy who has a fever or feels unwell should be treated as having neutropenic sepsis until shown otherwise. Mortality rises with delay, and the neutrophil count can take hours.
Take blood cultures and give empirical broad-spectrum antibiotics according to local protocol within an hour of arrival, then refine when the count and cultures are back. Patients who are unwell but afebrile, or who have taken antipyretics, can still be neutropenic and septic.
- Treat fever or feeling unwell after recent chemotherapy as neutropenic sepsis until proved otherwise.
- Give empirical antibiotics within an hour, after blood cultures if they do not delay treatment.
- Do not wait for the neutrophil count.
- Remember that steroids and antipyretics can mask fever.
- Give patients a written alert card and a direct number to call.
Why it matters
Delays at triage, not drug choice, are the commonest avoidable failure in neutropenic sepsis.
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