Febrile neutropenia is a medical emergency that requires urgent evaluation, the timely administration of empiric broad-spectrum antimicrobials, and careful monitoring to optimize patient outcomes and mitigate the risk of complications. Fever in the setting of neutropenia can affect subsequent chemotherapy dosing and scheduling, which, in turn, affects treatment efficacy and overall prognosis. ASCO and the Infectious Disease Society of America (IDSA) have published clinical practice guidelines for the effective triage, risk stratification, and standardized management of this vulnerable patient population with a focus on patients who can safely be managed in the outpatient setting
The IDSA guideline on the general management of neutropenic patients with cancer was first published in 1997 and last updated in 2011.4 In the article that accompanies this commentary, Zimmer and Freifeld. Upon evaluating patients with febrile neutropenia, clinicians must differentiate between patients who can be safely treated and monitored as outpatients versus individuals who require inpatient hospitalization. ASCO/IDSA recently published updated recommendations for the identification of patients with febrile neutropenia who may be considered for outpatient management.
Time from triage to the delivery of antibiotics should not exceed 1 hour as delays are associated with complications and decreased survival. For patients who develop febrile neutropenia while receiving oral fluoroquinolone prophylaxis, monotherapy with an antipseudomonal B-lactam agent is recommended, with the addition of other antimicrobials if other complications arise, such as hemodynamic instability, or if antimicrobial resistance is suspected or proven