Fever:
- Single temperature equivalent to ≥38.3°C orally OR
- Equivalent to ≥38.0°C orally over 1-hour period
Neutropenia:
- ≤ 500 neutrophils/µl
- ≤ 1000 neutrophils/µl and a predicted decline to ≤ 500/µl over the next 48 hours
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Low risk None of the high-risk factor and most of the following - Outpatient status at the time of development of fever - No associated acute comorbid illness, independently indicating inpatient treatment or close observation - Anticipated short duration of severe neutropenia (≤100 cells/ul for 7 days) - Good performance status (ECOG 0-1) - No hepatic insufficiency - No renal insufficiency - MASCC Risk-Index Score of ≥21 or CISNE score of <3 Site of care - Home for selected low-risk patients with adequate outpatient infrastructure established or - Ambulatory clinic or - Hospital |
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Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
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Preferred |
Alternative |
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Low Risk (Outpatient) |
Amoxicillin-clavulanate 625mg PO q8h PLUS Ciprofloxacin 500mg PO q12h OR Levofloxacin 500mg PO q24h OR Moxifloxacin 400mg PO q24h |
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Criteria for oral therapy: No nausea or vomiting Patient able to tolerate oral medication patient not on prior fluoroquinolone prophylaxis Treat till counts > 0.5 x 109/L Can consider stopping the antibiotic after reassessing the patient following 2 days afebrile at the discretion of the treating hemato-oncologists- If the patient has stable vital signs, no evidence of ongoing infection, are educated about their condition and stay near to hospital facilities. |
Minimum duration of therapy for documented infection differs in different scenarios
Skin and soft tissue: 5-14 days
Blood–stream infections
- Gram-negative/ Gram Positive- 7-14 days
- Staphyloccus aureus: typically requires 4 weeks after negative blood culture
- Candida: minimum 2 weeks after negative blood culture
- Aspergillus: minimum 12 weeks