Febrile neutropenia can progress to septic shock within hours. Established guidance is to assess a patient on chemotherapy with fever promptly and to give empirical broad-spectrum intravenous antibiotics within an hour of arrival, without waiting for the neutrophil count when neutropenia is likely.
Patients should be told to come in straight away with a fever after chemotherapy, and given written instructions and a contact number. Risk tools such as the MASCC score can then identify the minority suitable for oral or outpatient treatment.
- Give every patient on chemotherapy written fever instructions and a 24-hour contact number.
- Start empirical intravenous antibiotics within an hour of arrival when febrile neutropenia is possible.
- Take blood cultures first, but do not delay antibiotics for them.
- Use a validated risk score before considering outpatient management.
Why it matters
Delay to the first antibiotic dose is one of the few modifiable drivers of death in febrile neutropenia.
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