Acute Oncology Guidelines
- 7-day course of co-amoxiclav 625mg TDS + oral ciprofloxacin 500mg BD (see Antibiotic management of neutropenic sepsis or febrile neutropenia: important notes point 6).
- If penicillin allergy, give oral cotrimoxazole 960mg BD.
- Cover any specific suspected organisms with additional antibiotics as indicated.
Outpatient management of low risk adult oncology patients with febrile neutropenia
Warning
Part 1 - Triage and initial management - see Febrile neutropenia management pathway: important notes.
Part 2 - Identification of candidates for outpatient management.
Use a validated scoring system to assess level of risk for serious medical complications associated with febrile neutropenia- MASCC (available also as an MDCalc online calculator or app)
- All cases of discharge should be discussed with the on-call oncology registrar contactable via switchboard so that patients can be added to the ‘call back’ list.
- Patients should have hourly obs for ≥ 4 hours before discharge and only discharged if condition stable.
- Residence ≤ 1 hour from nearest emergency department.
- Must have a family member or caregiver at home.
Callback from cancer assessment unit triage team daily for 3 days following discharge to assess symptoms over the phone and chase any outstanding test results (for example urine and blood cultures)
Low threshold for admission to hospital if:
- Continues to have fevers 48 hours after broad spectrum empirical oral antibiotics.
- New signs or symptoms or infection.
- Blood culture results identify species not susceptible to the initial regime.
- Develop breathlessness, cough or myalgia.