How should I manage a patient with neutropenia who is at risk of infection?

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 ¹,².
• 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 ¹.
• Empiric antibiotic therapy: Start empiric antibiotic treatment immediately in suspected neutropenic sepsis. Piperacillin with tazobactam is recommended as initial empiric therapy unless contraindicated ¹. Aminoglycosides or glycopeptides should not be routinely used initially unless specific indications exist ¹.
• 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 ¹.
• 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 ¹.
• 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 ¹.
• Prevention: For adults with anticipated significant neutropenia due to chemotherapy, offer prophylaxis with ciprofloxacin during the expected neutropenic period only, monitoring for antibiotic resistance ¹. Do not routinely offer G-CSF unless part of chemotherapy regimen or to maintain dose intensity ¹.