Febrile Neutropenia

Separate specialist guidelines for the empirical treatment of febrile neutropenia in Haematology and Oncology Patients are available on the NUH document library

Definition of neutropenia

Neutrophils < 1.0 x 10⁹/L

Suspicion of Neutropenia defined as: Chemotherapy within 4 weeks or haematology patients (unlike oncology) may very often be neutropenic due to their blood disorder without any prior exposure to chemotherapy in the last 4 weeks.

Fever defined as: Temp >38.5^oC on 1 occasion or Clinical signs of septicaemia/obvious focus of infection or Temp> 38^oC on two occasions separated by 1 hour or good history of fever detected by patient before admission.

If temperature 37-38°C repeat after one hour to see if the above criteria for treatment are met.

Summary of current regimens

Haematology-

• Piperacillin/Tazobactam IV 4.5g tds (if not penicillin allergic) + Gentamicin IV 5mg/kg (max 500mg ) od reduce dose if renal impairment or elderly patients). Monitor levels.
• If gentamicin-resistant organisms, use amikacin in it's place, following microbiology advice.
• If penicillin allergic or unresponsive to initial therapy see full guideline (pg46) for further information.

Oncology

• Piperacillin/Tazobactam IV 4.5g tds (if not penicillin allergic)
  • +/- Gentamicin if septic (IV 5mg/kg od to a maximum 500mg) reduce dose if renal impairment or elderly patients).
  • +/- vancomycin if line infection suspected (IV 1g bd; adjust dose if >65 yrs or renal impairment) .
  • If patient is penicllin allergic see full guideline for further information.
  • For a full copy of the Oncology neutropenic sepsis guideline Click here

Other patients

• Temperature over 38.0^oC AND neutrophil count < 1.0 x 10⁹/l
• Take line and peripheral blood cultures
• Piperacillin/Tazobactam IV 4.5 g 8 hourly if not penicillin allergic.
• Add Gentamicin if septic (5mg/kg od to a maximum 500mg) unless renal impairment. Monitor levels.
• Add vancomycin if line- infection suspected (IV 1g bd, reduce dose to 1g od if >65 years or renal impairment.

Page last edited: 17/03/2009

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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