Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy
Guideline Status: Current
Published Online: February 20, 2018
Last Updated: March 21, 2023
Published online ahead of print February 20, 2018, doi: 10.1200/JCO.2017.77.6211
Randy A. Taplitz, Erin B. Kennedy, Eric J. Bow, Jennie Crews, Charise Gleason, Douglas K. Hawley, Amelia A. Langston, Loretta J. Nastoupil, Michelle Rajotte, Kenneth Rolston, Lynne Strasfeld, and Christopher R. Flowers
Purpose
To provide an updated joint ASCO/Infectious Diseases Society of American (IDSA) guideline on outpatient management of fever and neutropenia in patients with cancer.
Methods
ASCO and IDSA convened an Update Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel.
Results
Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.
Recommendations
Clinical judgment is recommended when determining which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index. In addition, psychosocial and logistic considerations are outlined within the guideline. The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for ≥ 4 hours before discharge. An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if penicillin allergic) is recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis was used before fever developed. Patients who do not defervesce after 2 to 3 days of an initial, empirical, broad-spectrum antibiotic regimen should be re-evaluated and considered as candidates for inpatient treatment.
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