Febrile Neutropenia Management (Adults) Clinical Guideline
Version 2.0 approved 18 October 2023
The Febrile Neutropenia Management (Adults) Clinical Guideline (PDF 313KB) has been developed by the South Australian expert Advisory Group on Antimicrobial Resistance (SAAGAR) to guide clinicians towards best practice in the initial management of febrile neutropenia in adult patients.
The aim of this guideline is to assist clinicians to:
- Determine probable febrile neutropenia
- Stabilise the patient
- Order the relevant investigations
- Consider the need for intensive care unit (ICU) consultation or transfer to a tertiary centre
- Prescribe appropriate initial antibiotic therapy
Ongoing therapy and duration of therapy should be determined by the patient’s response, isolation of a pathogen, and rate of neutrophil recovery.
Key stewardship points
- Administer IV antibiotics within 30 minutes of presentation for greatest survival benefit.
- Obtain blood cultures before commencing antibiotics but do not delay if there is difficult access.
- If available, review recent microbiology for positive cultures to guide antibiotic choice to cover previous isolates.
- Monotherapy with an anti-pseudomonal beta-lactam antibiotic is the recommended first line empiric treatment in clinically stable patients with no signs of sepsis or septic shock.
- Adjust treatment as soon as additional information is available (e.g., source of infection, results of Gram stain, culture, or susceptibility testing), or there is no improvement after 48 hours.
- Duration of antibiotic therapy is dependent on response to antibiotic therapy, rate of neutrophil recovery, and resolution of infection.