Low Risk Febrile Neutropenia

  • Administer first dose of PO antibiotic and monitor for tolerance

  • Observe for a minimum of 4 hours from first dose antibiotic to confirm low risk status and tolerability of oral antibiotics

Empiric Treatment

  • Dose adjustment required in renal impairment

OR

  • Dose adjustment required in renal impairment

AND

  • Dose adjustment required in renal impairment

Patient Unable to Tolerate PO

If patient is unable to tolerate PO antibiotcs then proceed to IV therapy recommendations for high risk patients

Considerations for Outpatient Management

If patient meets ALL criteria below, consider managing as an outpatient. If criteria not satisfied, admit patient on oral antibiotics.

Call oncologist or internal medicine on-call to review case and the appropriateness of outpatient management.

Outpatient Management Criteria for Patients at Low-Risk:

  • Appropriate for outpatient management as per the clinical judgement of the clinician

  • Patient can tolerate oral medications

  • Patient can afford and access prescribed oral antibiotics

  • Patient has 24 hour caregiver readily accessible

  • Patient has access to ER

  • Patient can return to facility easily within 1 hour

  • Patient can return for follow-up clinic visits within 24 to 48 hours

  • Patient caregiver has a telephone

  • Patient capable and reliable to self-monitor and self-administer treatment

  • Arrange for outpatient follow-up visit (oncology or ER) within next 24 to 48 hours

  • Provide patient education prior to discharge

  • Provide lab requisition for CBC, electrolytes, Ca, Mg, Phos and serum creatinine every 2 days x 3

  • Explain to the patient they are being treated for fever after chemotherapy with antibiotics as an outpatient and regarding the importance of monitoring symptoms and follow-up appointments

  • Instruct the patient to record their symptoms and temperature morning, noon, evening and at bedtime using a diary for at least 3 days

  • Instruct the patient to return to the Emergency Department immediately if:

    • New signs of infection such as: shortness of breath; cough; chills; diarrhea; nausea; vomiting or open sores or wounds that are not healing or are worsening.
    • In the absence of new or worsening symptoms, persistent or recurrent fever greater than 48 to 72 hours after starting antibiotics (defined as a temperature ≥ 38.3 ⁰C (101 ⁰ F) or ≥ 38 ⁰C (101 ⁰F) sustained over a 1 hour period).
    • Unable to tolerate oral antibiotics due to nausea, vomiting, diarrhea or rash.