Inpatient Febrile Neutropenia

Inpatient Febrile Neutropenia

Guideline Use

Utilize the Severe Sepsis/Septic Shock guidelines

Dose recommendations are based on patients with normal renal function. Refer to dosing in renal impairment

These guidelines may not be appropriate for patients with a history of multi-drug resistant organisms. Consider infectious disease consultation


Meets ANC AND Temperature Criteria:

  • Absolute Neutrophil Count (ANC), either:
    • ANC <500, OR
    • ANC <1000 and predicted to devline to <500 w/in 48 hours
  • Temperature, either:
    • 38.3°C (101 F), OR
    • 38°C (100.4 F) >1 hour
  • H&P for localizing findings

  • History of multi-drug resistant organisms (MDRO)

  • Receipt of prophylactic antibiotics (ex. Levofloxacin)

  • Presence of organ dysfunction

  • Drug allergies

  • Blood cultures x 2 for all patients

  • Additional cultures as indicated by suspected source

Management Considerations

50% of episodes are of unknown source

Median time to defervescence is ~5 days

Avoid fluoroquinolones if receiving them prophylactically


ANC >500 on at least one occasion with an increasing trend

Antimicrobials may be narrowed to target cultured organisms

Additional Information

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making. Definitive therapy should be based on culture and susceptibility reports

  • Rebekah Gass, MD
  • Louie Allen, MD
  • Kyle D. Massey, PharmD
  • EORTC. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. JID. 1991:136;951-958. Available here
  • Cometta et al. Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. CID. 2003:37;382-389. Available here