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Febrile neutropenia — RACP Paediatrics MCQ

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HardHaematology and oncologyFebrile neutropeniaRACP Paediatrics

A 6-year-old receiving induction chemotherapy presents with temperature 38.6°C and looks tired but is perfusing adequately. Absolute neutrophil count is 0.2 x 10^9/L. There is no central line exit-site infection. What is the most appropriate management?

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Correct answer: A — Give empirical intravenous anti-pseudomonal antibiotics immediately

Fever with severe neutropenia after chemotherapy is a medical emergency, even if the child initially appears stable. Empirical intravenous broad-spectrum antibiotics with anti-pseudomonal cover should be given promptly after cultures. Deterioration can be rapid because inflammatory signs may be muted.

Reference: RCH Fever and suspected or confirmed neutropenia guideline; Therapeutic Guidelines (eTG)