Febrile Neutropenia Antibiotics — RACP Adult Medicine MCQ

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EasyInfectious DiseasesFebrile Neutropenia AntibioticsRACP Adult Medicine

A 55-year-old man on chemotherapy for AML has been neutropenic (ANC 0.1 × 10⁹/L) for 12 days. He develops fever (38.8°C) and rigors. He has a Hickman line. He is haemodynamically stable. What is the most appropriate empirical antibiotic?

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Correct answer: B — IV piperacillin-tazobactam

Febrile neutropenia (ANC <0.5 + fever ≥38.3°C single or ≥38.0°C sustained for 1 hour) is a medical emergency requiring empirical IV broad-spectrum antibiotics within 60 minutes. First-line: anti-pseudomonal beta-lactam — piperacillin-tazobactam, cefepime, or meropenem (per local guidelines/resistance patterns). eTG 2025 recommends piperacillin-tazobactam as first-line. Add vancomycin ONLY if: line infection suspected, skin/soft tissue infection, MRSA risk, or haemodynamic instability. Blood cultures (peripheral + central line) BEFORE antibiotics but DO NOT delay treatment.

Reference: eTG Antibiotic – 2025 – Febrile Neutropenia; ASCO 2024