This handout is for neutropenic fever (febrile neutropenia). Your care team identified this based on: temp >=38.3 c (single) or >=38.0 c sustained >=1h + anc <500 cells/mcl — idsa 2010 freifeld; asco/idsa 2018 taplitz.
Other reasons your team may use this plan: anc <500 cells/mcl or expected to decline <500 within 48h — idsa 2010 freifeld; oncology patient on cytotoxic chemotherapy presenting with fever — nccn 2024.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| cefepime | 2 g IV q8h | IV | q8h | IDSA 2010 Freifeld — anti-pseudomonal monotherapy; ASCO/IDSA 2018 Taplitz first-line |
| piperacillin-tazobactam | 4.5 g IV q6h | IV | q6h | IDSA 2010 Freifeld — equivalent efficacy to cefepime; extended infusion preferred — ASCO/IDSA 2018 Taplitz |
| meropenem | 1 g IV q8h | IV | q8h | IDSA 2010 Freifeld — reserve for ESBL colonization or critically ill; broader spectrum — NCCN 2024 |
Plan: Febrile neutropenia empiric escalation ladder (IDSA 2010 Freifeld; ASCO/IDSA 2018 Taplitz; NCCN 2024)
Call 911 or go to the nearest emergency room right away if you have:
Continue abx until afebrile AND ANC >=500 rising; G-CSF consideration for high-risk patients or prolonged neutropenia; oncology follow-up for chemo dose adjustment; secondary prophylaxis assessment (fluoroquinolone or antifungal ppx next cycle) — IDSA 2010 Freifeld; ASCO/IDSA 2018 Taplitz; NCCN 2024
Guideline: IDSA 2010 Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer (Freifeld CID 2011); ASCO/IDSA 2018 Update on Outpatient Management (Taplitz JCO 2018); NCCN 2024 Prevention and Treatment of Cancer-Related Infections