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Febrile Neutropenia — RACP Paediatrics MCQ

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ModerateHaematology & OncologyFebrile NeutropeniaRACP Paediatrics

A child with acute lymphoblastic leukaemia develops fever (39.5°C) and neutropenia (ANC 0.3 × 10⁹/L) on day 14 of chemotherapy. He has a central venous access device (CVAD). What is the most appropriate initial empirical antibiotic?

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Correct answer: B — IV piperacillin-tazobactam or cefepime

Febrile neutropenia in a child with cancer is a medical emergency. Empirical broad-spectrum IV antibiotics covering Gram-negative organisms (including Pseudomonas aeruginosa) must be commenced within 60 minutes of presentation. Piperacillin-tazobactam or cefepime (or meropenem if penicillin-allergic) is recommended as first-line. Vancomycin is added if CVAD infection or Gram-positive bacteraemia is suspected.

Reference: ANZCHOG – 2024 – Supportive Care Guidelines: Febrile Neutropenia in Children with Cancer