What is the definition of febrile neutropenia, and how should it be managed?
Points of discussion:
- Febrile neutropenia (FN) is defined as an oral temperature >38.5°C or two consecutive readings of >38.0°C for 2 h and an absolute neutrophil count <0.5 × 109/l, or expected to fall below 0.5 × 109/l
- Every patient requires:
- Blood cultures (peripheral and Port/PICC sites)
- Urine culture
- CXR
- +/- culture of other sources of possible infection (eg.. C. difficile collection if diarrhea, throat swab if odynophagia)
- Special considerations:
- Sinusitis
- Herpes simplex
- Herpes zoster
- Thrush
- Avoid acetaminophen orders which may mask fevers (can order prn acetaminophen if fever already document, please avoid standing acetaminophen orders)
- Avoid suppositories, enemas, or rectal probing while neutropenic
Treatment:
- Neupogen (5ug/kg) until neutrophils at least >0.5 x 10 9/L
- No evidence to support single vs double agent therapy:
- single agent β-lactam such as cefepime, carbapenem or piperacillin / tazobactam
- There is no role for addition of aminoglycosides unless critically ill with suspected gram negative infection
- VANCO or Linezolid
- Port / line infection
- Mucositis
- MRSA colonization
- Recent quinolone prophylaxis
- Prolonged fever
