What do the IDSA guidelines recommend for the empiric treatment of febrile neutropenia?

20 June, 2018

Q15. What do the IDSA guidelines recommend for the empiric treatment of febrile neutropenia? 

Summary: The IDSA guidelines recommend stratifying patients into low risk (Multinational Association for Supportive Care in Cancer [MASCC] >21: anticipated neutropenia ≤7 days, clinically stable with no medical comorbidities) or high risk (MASCC <21: anticipated neutropenia >7 days, or clinically unstable with any medical comorbidities). High-risk patients should then be treated with parenteral broad-spectrum antibiotics with coverage over likely pathogens. If they have no significant risk of methicillin-resistant Staphylococcus aureus (MRSA), monotherapy with a broad-spectrum anti-pseudomonal beta-lactam can be given but if there is concern about MRSA, or if the patient is seriously ill with significant comorbidity, vancomycin should be added. Low-risk patients, who are not acutely ill with a reasonable absolute neutrophil count (ANC) can be treated as outpatients with a fluoroquinolone plus amoxicillin-clavulanate. If the low-risk patients require hospitalization they can still be treated orally with a fluoroquinolone plus amoxicillin-clavulanate.