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Low-Risk Febrile Neutropaenia — RACP Adult Medicine MCQ

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ModerateMedical OncologyLow-Risk Febrile NeutropaeniaRACP Adult Medicine

A 55-year-old woman with breast cancer receiving dose-dense AC chemotherapy (doxorubicin + cyclophosphamide) develops fever 10 days after her second cycle. ANC is 0.2 × 10⁹/L. She has a temperature of 38.5°C and is haemodynamically stable with no localising source. The MASCC score is 22 (high risk if <21). What is the appropriate setting for management?

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Correct answer: D — Outpatient oral antibiotics

The MASCC score of 22 identifies this patient as LOW risk for serious complications from febrile neutropaenia (score ≥21 = low risk). Low-risk febrile neutropaenia can be managed with outpatient oral antibiotics (amoxicillin-clavulanate + ciprofloxacin) provided: reliable follow-up within 24 hours, ability to take oral medications, proximity to hospital, no significant comorbidities, and patient understanding. This approach is supported by multiple RCTs and eTG guidelines. High-risk patients (MASCC <21) require hospital admission.

Reference: eTG – 2025 – Antibiotic Guidelines; ASCO – 2018 – Febrile Neutropaenia Guidelines