Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of a patient with neutropenia at risk of infection involves:
- Immediate assessment and referral: Suspect neutropenic sepsis in patients with neutropenia who become unwell, especially those receiving anticancer treatment, and refer them immediately for assessment in secondary or tertiary care as this is a medical emergency NICE CG151,NICE NG51.
- Risk assessment: A healthcare professional competent in managing anticancer treatment complications should assess the patient's risk of septic complications within 24 hours using a validated risk scoring system NICE CG151.
- Empiric antibiotic therapy: Start empiric antibiotic treatment immediately in suspected neutropenic sepsis. Piperacillin with tazobactam is recommended as initial empiric therapy unless contraindicated NICE CG151. Aminoglycosides or glycopeptides should not be routinely used initially unless specific indications exist NICE CG151.
- Monitoring and reassessment: For high-risk patients, daily clinical review and risk reassessment are essential. Do not switch initial empiric antibiotics unless there is clinical deterioration or microbiological indication NICE CG151.
- Outpatient management: Consider outpatient antibiotic therapy for low-risk patients after careful assessment of social and clinical circumstances, ensuring patients understand when to return promptly if problems develop NICE CG151.
- Duration of treatment: Continue inpatient empiric antibiotics in patients with unresponsive fever. Discontinue antibiotics once neutropenic sepsis has responded to treatment, regardless of neutrophil count NICE CG151.
- Prevention: For adults with anticipated significant neutropenia due to chemotherapy, offer prophylaxis with ciprofloxacin during the expected neutropenic period only, monitoring for antibiotic resistance NICE CG151. Do not routinely offer G-CSF unless part of chemotherapy regimen or to maintain dose intensity NICE CG151.