In a patient on chemotherapy, fever with a neutrophil count below 0.5 × 10⁹/L — or expected to fall below it — is an emergency. Infection can progress quickly, and classic signs may be absent because there are too few neutrophils to mount them.
Broad-spectrum intravenous antibiotics with antipseudomonal cover should be given within an hour of presentation, after blood cultures but without waiting for the count if the patient is unwell. Risk scores such as MASCC can identify low-risk patients suitable for oral or outpatient treatment once assessed. Patients should carry clear instructions to present immediately with fever.
- Give broad-spectrum IV antibiotics within one hour to febrile patients on chemotherapy.
- Take blood cultures first, but do not delay antibiotics for results or a blood count.
- Use a risk score such as MASCC to identify low-risk patients for oral or outpatient care.
- Give every chemotherapy patient written advice to present at once with a fever.
Why it matters
Delays in the first hour are a common and preventable cause of death on chemotherapy.
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