Febrile neutropenia
Definition, antibiotics within 60 minutes, risk stratification with MASCC and CISNE, who can go home on oral antibiotics, what to do when fever persists, when to stop antibiotics, and G-CSF and prophylaxis.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Febrile neutropenia is a medical emergency. Gram-negative sepsis can kill within hours, and the usual signs of infection are blunted.
- Definition (TG, eviQ): a single temperature of 38.0°C or more with neutrophils under 0.5 x 10^9/L, or under 1.0 and expected to fall below 0.5.
- Antibiotics within 60 minutes: an antipseudomonal beta-lactam, piperacillin-tazobactam or cefepime.
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Sources
- Antibiotic (Therapeutic Guidelines), febrile neutropenia topicAU/NZTherapeutic Guidelines Ltd, Febrile neutropenia revised April 2026
- Introduction to the 2024 Consensus Guidelines for the Management of Neutropenic Fever in Patients with CancerAU/NZThursky KA et al., Intern Med J 2025;55 Suppl 7:9-19, 2024 (published 2025)
- Consensus guidelines for initial management of neutropenic feverAU/NZDouglas AP et al., Intern Med J 2025;55 Suppl 7:43-67, 2024 (published 2025)
- Consensus guidelines for the subsequent management of neutropenic fever after empiric therapyAU/NZDouglas AP et al., Intern Med J 2025;55 Suppl 7:68-94, 2024 (published 2025)
- Consensus guidelines for ambulatory care for neutropenic feverAU/NZTeh JSK et al., Intern Med J 2025;55 Suppl 7:95-114, 2024 (published 2025)
- Consensus guidelines for antibacterial prophylaxis in patients with neutropeniaAU/NZLindsay J et al., Intern Med J 2025;55 Suppl 7:115-35, 2024 (published 2025)
- eviQ, Immediate management of neutropenic feverAU/NZCancer Institute NSW
- Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline updateTaplitz RA et al., J Clin Oncol 2018;36:1443-53, 2018
- The Multinational Association for Supportive Care in Cancer risk indexKlastersky J et al., J Clin Oncol 2000;18:3038-51, 2000
- Clinical Index of Stable Febrile Neutropenia (CISNE)Carmona-Bayonas A et al., J Clin Oncol 2015;33:465-71, 2015
- Clinical-driven discontinuation of empirical antimicrobials in haematological patients with febrile neutropenia (How Long)Aguilar-Guisado M et al., Lancet Haematol 2017;4:e573-83, 2017
- Updated Australasian consensus guidelines for the management of invasive fungal disease and use of antifungal agents in the haematology/oncology setting, 2021AU/NZChang CC, Teh BW et al., Intern Med J 2021;51 Suppl 7:3-17, 2021
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy