Febrile neutropenia

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Oncology patients should be treated according to Guidelines for Neutropenic Sepsis here(intranet only).

Haematology patients should be treated according to the Antimicrobial Treatment Policy here(intranet only)

ALL OTHER PATIENTS: Follow guidance below

Assessment

Assess for sepsis using Sepsis 6.

If temperature >38oC and neutrophils 0.5 x 109/L or lower take the recommended investigations and start treatment as outlined below. 

Required investigations

  • Baseline bloods: FBC, U+E, LFT, CRP, Lactate
  • Blood Cultures x2
  • Other microbiological samples based on symptoms - e.g. urine for culture, viral and bacterial throat swabs, sputum for culture.

Antibiotic recommendations

Recommended total duration: 5 days if no source evident and evidence of sepsis have settled in 48-72 hours.

Antibiotic Recommendations
Source identified Treat as per guidance for that condition
Source unknown Treat as sepsis of unknown source

 

DISCUSS EARLY WITH MICROBIOLOGY

Neutropenia in a non-immunosuppressed patient can be a sign of severe sepsis.

Notes

  • Do not switch initial empiric antibiotics in patients with unresponsive fever within the first 48 hours unless there is clinical deterioration or a microbiological indication
  • Review at 48-72 hours consider stop or justify continue.
  • The neutrophil count does NOT need to be >0.5 for antibiotics to be stopped if the patient has improved within 48 hours and is afebrile for 24 hours at the time the antibiotics stop.