Febrile Neutropenia

Febrile Neutropenia

Patient Criteria

  • Temperature 38ºC or higher


  • ANC less than 1 X 10⁹/L


  • Meets one or more of high risk factors requiring admission (see below)

If patient meets one or more of the below high risk factors, ADMIT:

  • Hemodynamic instability
  • Inpatient status at time of fever
  • Temperature greater than 39ºC
  • Severe neutropenia
    • Less than or equal to 0.5 x 10⁹/L for more than 7 days
    • Less than or equal to 0.1 x 10⁹/L
  • Presence of potential complications, including:
    • Neurologic changes/confusion
    • Pneumonia, tachypnea (RR greater than 25 breaths/min), hypoxia, dyspnea
    • New onset of abdominal pain/diarrhea
    • Severe mucositis
    • Skin/soft tissue infection
    • Intravascular catheter infection
  • High risk cancer status
    • Uncontrolled, progressive cancer
    • Hematologic malignancy
  • Significant comorbid factors
    • Age greater than 70, physically/medically frail
    • Underlying lung disease
    • Hepatic insufficiency (liver function tests greater than 5 times normal)
    • Renal insufficiency (Serum creatinine greater than 176 umol/L)
    • Poor performance status (ECOG greater than 1)
  • Infectious diseases history
    • Taking antibiotics less than 72 hours before presentation
    • History of antibiotic resistant bacteria
      • Exception: For those with previous history/colonization of MRSA, low risk outpatient management may be considered if patient is clinically stable

Eligible for outpatient treatment if patient meets none of the above high risk factors AND meets following outpatient criteria:

  • Reliable patient/home support, who can return to facility easily
  • Can take oral medications
  • Can be easily contacted for daily assessment
  • Can be admitted urgently if clinically unwell/unstable

Note: NOT eligible for outpatient treatment if patient cannot meet outpatient criteria, despite having none of the above high risk factors; will need to admit