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Low-Risk FN Oral Antibiotics — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesLow-Risk FN Oral AntibioticsRACP Adult Medicine

A 65-year-old woman with breast cancer on adjuvant chemotherapy (docetaxel) develops fever 38.5°C on day 10 post-chemo. ANC is 0.3 × 10⁹/L. She is clinically well, haemodynamically stable, with no indwelling line, and no comorbidities. MASCC score is 23 (low risk, ≥21). She lives close to hospital with good support. What is the most appropriate management?

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Correct answer: B — Oral ciprofloxacin

Low-risk febrile neutropenia (MASCC ≥21: solid tumour, no hypotension, no COPD, no dehydration, age <60, outpatient at onset, no prior fungal infection) may be managed with oral antibiotics and outpatient monitoring. Oral regimen: ciprofloxacin 500 mg BD + amoxicillin-clavulanate 875/125 mg BD (per ASCO/IDSA). Daily review for first 3 days. Escalate to IV antibiotics if clinical deterioration. This approach reduces hospital stay and improves quality of life.

Reference: ASCO – 2024 – Low-Risk FN; MASCC Score; eTG Antibiotic 2025