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.