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Febrile Neutropaenia — RACP Adult Medicine MCQ

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ModerateHaematologyFebrile NeutropaeniaRACP Adult Medicine

A 68-year-old man with diffuse large B-cell lymphoma is being treated with R-CHOP. He presents 10 days after cycle 1 with a temperature of 38.8°C and an absolute neutrophil count of 0.3 × 10⁹/L. He appears well with no localising source of infection. What is the most appropriate empirical antibiotic?

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Correct answer: A — IV piperacillin-tazobactam

Febrile neutropaenia (temperature ≥38.3°C single reading or ≥38.0°C sustained for 1 hour with ANC <0.5 × 10⁹/L) requires prompt empirical broad-spectrum antibiotics. eTG recommends piperacillin-tazobactam as first-line monotherapy for low-risk febrile neutropaenia without clinical instability. Meropenem is reserved for high-risk patients or those with prior resistant organisms. Vancomycin is added only for specific indications (e.g. catheter-related infection, skin/soft tissue infection, mucositis with suspected Gram-positive bacteraemia).

Reference: eTG – 2025 – Antibiotic Guidelines; ACSQHC – 2019 – Antimicrobial Stewardship in Cancer