Febrile NeutropeniaEmergency

Chemo 8 days ago, now T 38.6 °C, ANC 0.2 — treat as sepsis with an hour on the clock: cultures then piperacillin-tazobactam immediately.

• T ≥38.3 or hypothermia with ANC <0.5
• Hypotension, tachycardia, confusion
• Line-site erythema or perianal pain
• New cough/hypoxia — pneumonia progresses fast

• Central line infection
• Pneumonia, typhlitis (neutropenic enterocolitis)
• Invasive fungal infection
• Drug fever (less likely early)

• Antibiotics: Antipseudomonal within 1 h — every patient
• Vancomycin: Line infection, skin/soft tissue, shock, MRSA, mucositis only
• Outpatient: MASCC ≥21 + solid tumour + stable + support at home

• Door-to-needle <1 h is the quality standard — treat before the count returns
• Gram-negative rods kill fastest — antipseudomonal cover is non-negotiable
• Documented β-lactam allergy: ciprofloxacin + clindamycin, or aztreonam + vancomycin
• No fever ≠ no infection: neutropenic patients may present hypothermic or just 'unwell'

• Delay antibiotics for the neutrophil count or imaging results
• Add vancomycin routinely — no benefit, real toxicity
• Give PRBC or platelets for stable numbers without thresholds (platelets <10, or <50 if bleeding) — discuss each

• Rectal examination/suppositories in neutropenia — bacteraemia risk
• Co-amoxiclav alone (no pseudomonal cover)
• Keeping vancomycin beyond 48 h negative cultures
• Forgetting antifungals at 96 h

Continue IV antibiotics until afebrile ×48 h AND ANC recovering (>0.5); total course per source; oncology notified to adjust next cycle.