Febrile neutropenia is having a fever of ≥38.3 ºC or ≥38 ºC over an hour and neutropenia that is having an absolute neutrophil count (ANC) of <500 neutrophils/mm3 or an ANC <1000 neutrophils/mm3 expected to decline to ≤500 neutrophils/mm3 over the next 48 hours.
The risk of febrile neutropenia is directly proportional to the duration and severity of neutropenia.
Fever is frequently the only indication of infection in the neutropenic patient.

Febrile Neutropenia References

  1. Brown CH. Febrile neutropenia infections. US Pharm. 2013;38(5)(Oncology Suppl):3-7. Accessed 05 Sep 2013
  2. De Naurois J, Novitzky-Basso I, Gill MJ, et al. Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol. 2010 May;21(Suppl 5):v252-v256. doi: 10.1093/annonc/mdq196. PMID: 20555092
  3. D’Antonio D, di Girolamo A, Iacone A, et al. Evaluation of azlocillin-amikacin combination for empirical therapy of infection in febrile neutropenic patients. J Chemother. 1989 Dec;1(6):407-412. PMID: 2693624
  4. DePauw BE, Deresinski SC, Feld R, et al. Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer: a multicenter randomized trial. Ann Intern Med. 1994 May;120(10):834-844. PMID: 8154643
  5. Fishman A, Chowers M, Altaras M, et al. Aztreonam plus piperacillin-empiric treatment of neutropenic fever in gynecology-oncology patients receiving cisplastin-based chemotherapy. Eur J Gynaecol Oncol. 1998;19(2):126-129. PMID: 9611050
  6. Freifeld A, Marchigiani D, Walsh T, et al. A double blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999 Jul;341(5):305-311. PMID: 10423464
  7. Freifeld AG, Bow EJ, Sepkowitz KA, et al; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer:2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb;52(4):e56-e93. doi: 10.1093/cid/cir073. PMID: 21258094
  8. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002 Mar;34(6):730-751. PMID: 11850858
  9. Infectious Diseases Society of Taiwan, Hematology Society of Taiwan, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsien for the Infectious Diseases Research and Education, CY Lee’s Research Foundation for Pediatric. Guidelines for the use of antimicrobial agents in patients with febrile neutropenia in Taiwan. J Microbiol Immunol Infect. 2005 Dec;38(6):455-457. PMID: 16341349
  10. Link H, Bohme A, Cornely OA, et al. Antimicrobial therapy of unexplained fever in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemein. Ann Hematol. 2003 Oct;82(Suppl 2):S105-S117. PMID: 13680173
  11. Kern WV, Cometta A, De Bock R, et al. Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. N Engl J Med. 1999 Jul;341(5):312-318. PMID: 10423465
  12. Jun HX, Zhixiang S, Chun W, et al. Clinical guidelines for the management of cancer patients with neutropenia and unexplained fever. Int J Antimicrob Agents. 2005 Dec;26(Suppl 2):S128-S132. PMID: 16253480
  13. Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med. 2004 Sep;351(14):1391-1402. PMID: 15459300
  14. Peacock JE, Herrington DA, Wade JC, et al. Ciprofloxacin plus piperacillin compared with tobramycin plus piperacillin as empirical therapy in febrile neutropenic patients: a randomized, double-blind trial. Ann Intern Med. 2002 Jul;137(2):77-86. PMID: 12118962
  15. Mortimer J, Miller S, Black D, et al. Comparison of cefoperazone and mezlocillin with imipenem as empiric therapy in febrile neutropenic cancer patients. Am J Med. 1998 Jul;85:17-20. PMID: 3400679
  16. MedWormhttp://www.medworm.com/rss/index.php/Cancer-%26-Oncology/6/http://www.medworm.com/rss/medicalfeeds/specialities/Cancer-Oncology.xml
  17. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  18. NCCN Fever and Neutropenia Panel Members. Fever and neutropenia. Version 1.2004. NCCN practice guidelines in oncology - v.1.2004. http://www.nccn.org/professionals/physician_gls/PDF/fever.pdf.Peacock. 2004
  19. Ahmed NM. Management of fever in children with non- chemotherapy-induced neutropenia. UpToDate. http://www.uptodate.com/contents/management-of-fever-in-children-with-non-chemotherapy-induced-neutropenia?source=search_result&selectedTitle=1~150. Sep 2010. Accessed 14 Feb 2011
  20. Robbins GK. Fever in the neutropenic adult patient with cancer. UpToDate. http://www.uptodate.com/contents/fever-in-the-neutropenic-adult-patient-with-cancer?source=. Sep 2010. Accessed 14 Feb 2011
  21. Bertuch AA. Fever in children with chemotherapy-induced neutropenia. UpToDate. http://www.uptodate.com/contents/fever-in-children-with-chemotherapy-induced-neutropenia?source=search_result&selectedTitle=2~150.Sep. Sep 2010. Accessed 14 Feb 2011
  22. National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections. NCCN Practice guidelines in oncology - v.2.2009. http://www.oralcancerfoundation.org/treatment/pdf/infections-NCCN.pdf. Accessed 16 Feb 2011
  23. National Comprehensive Cancer Network Myeloid Growth Factors Panel Members. Myeloid growth factors. NCCN Practice guidelines in oncology - v.1.2010. http://jhasioncolog.com/fn2010/eresourcecenter/pdfs/NCCN%20myeloid_growth%20factor%20guidelines.%20v1.2010.pdf. 2010. Accessed 16 Feb 2011
  24. Klastersky J, de Naurois J, Rolston K, et al. Management of febrile neutropaenia: European Society for Medical Oncology (ESMO) clinical practice guidelines. Ann Oncol. 2016 Sep;27(Suppl 5):v111-v118. doi: 10.1093/annonc/mdw325. PMID: 27664247
  25. Averbuch D, Orasch C, Cordonnier C, et al; ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013 Dec;98(12):1826-1835. doi: 10.3324/haematol.2013.091025. PMID: 24323983
  26. Bow E. Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications. UptoDate. https://www.uptodate.com/. Jan 2020. Accessed 26 Jul 2019.
  27. Carmona-Bayonas A, Jimenez-Fonseca P, de Castro EM, et al. SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol. 2019 Jan;21(1):75-86. doi: 10.1007/s12094-018-1983-4. PMID: 30470991
  28. National Comprehensive Cancer Network. Hematopoietic growth factors. Version 2.2020. NCCN. https://www.nccn.org/. Jan 2020. Accessed 26 Jul 2019.
  29. National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections. Version 1.2020. NCCN. https://www.nccn.org/. Dec 2019. Accessed 26 Jul 2019.
  30. Smith TJ, Bohlke K, Lyman GH, et al; American Society of Clinical Oncology. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2015 Oct;33(28):3199-3212. doi: 10.1200/JCO.2015.62.3488. PMID: 26169616
  31. Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA Clinical Practice Guideline update. J Clin Oncol. 2018 Oct;36(30):3043-3054. doi: 10.1200/JCO.18.00374. PMID: 30179565
  32. Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline update. J Clin Oncol. 2018 May;36(14):1443-1453. doi: 10.1200/JCO.2017.77.6211. PMID: 29461916
  33. Wingard JR. Diagnostic approach to the adult cancer patient with neutropenic fever. UptoDate. https://www.uptodate.com/. Jan 2020. Accessed 26 Jul 2019.
  34. Wingard JR. Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients). UptoDate. https://www.uptodate.com/. Jan 2020. Accessed 26 Jul 2019.
  35. Wingard JR. Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults. UpToDate. https://www.uptodate.com/. Jan 2020.
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 03 Sep 2018

The rate of syphilis reactivity appears to be higher in individuals with dementia compared with those without the condition, a Singapore study has found.

12 Jun 2019
Urogenital infections remain a major reason for women to visit their family physician and their subsequent referral to obstetrics and gynaecology or urology specialists. The association between abnormal vaginal microbiota and an increased risk of contracting sexually transmitted diseases (STDs), as well as an increased rate of preterm labour, indicates the need to better understand and manage urogenital health in women. Probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”. As such, there is a sound rationale for using probiotics to maintain female vaginal and bladder health.
Tristan Manalac, 2 days ago
Elderly coronavirus disease 2019 (COVID-19) patients with high nutritional risk appear to suffer worse outcomes, such as longer hospital stay and greater disease severity, according to a recent study.
Jairia Dela Cruz, 16 Apr 2020
The odds of women passing coronavirus disease 2019 (COVID-19) to their sexual partners appear to be low, with two studies showing no evidence of the disease-causing SARS-CoV-2 virus existing in the vaginal fluids of infected patients.