Febrile Neutropenia

Febrile Neutropenia

Always notify on-call medical oncologist of ER visit or Admission for febrile neutropenia


  • Single oral temp of ≥38.3ºC or fever ≥38.0ºC lasting at least one hour


  • A neutrophil count of ≤0.5x10⁹/L or ≤1.0x10⁹/L if expected to fall to ≤0.5 within 48hrs

Mild: 1000-1500 cells/mm3 Moderate: 500-1000 cells/mm3 Severe: < 500 cells/mm3

ADD Vancomycin empirically if:

  • Hemodynamic instability or septic shock

  • Positive blood culture for beta-lactam resistant gram-positive organism

  • Clinical evidence of catheter-related infection

  • Skin or soft tissue infection

  • Known MRSA colonization

Low risk patients

  • Outpatient with controlled malignancy or in remission

  • ANC >100 cells/mm3

  • Resolution of neutropenia expected within 10 days

  • Absolute monocyte count greated than 1x108 cells/L

  • Normal findings on CXR

  • Nearly normal results of hepatic and renal function tests

  • No evidence of central IV catherter site/line infection

  • No signs or symptoms of systemic infection (excluding fever)

  • No significant comorbid illnesses

  • Peak temperature less than 39ºC

  • No neurological or mental status changes

  • RR < 24 rpm

  • No nausea/vomiting/diarrhea or severe mucositis

  • No antibiotic use (IV or PO) within 7 days

  • No known allergy to quinolones

  • Can take oral medications, fluids and can be contacted easily for daily assessments

High risk patients

If patient does not qualify for low risk is categorized as high risk (i.e. does not meet any one criteria from the low risk)

Reassessment after 48-72 hours