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
- Study type
- Clinical guideline
- Study name
- ASCO/IDSA Outpatient Febrile Neutropenia 2018
- Design
- Clinical practice guideline update based on a systematic review of the evidence and expert panel consensus
- Sample size
- 6 new or updated meta-analyses and 6 new primary studies added to the systematic review
- Source
- JCO · 2018
In plain words
Sometimes in people with cancer who are having chemotherapy, the number of infection-fighting white blood cells falls and a fever develops. This is an emergency and must be treated straight away. This guideline says that the doctor will look at your situation and decide whether it is safe to be treated at home (as an outpatient) or whether you need to stay in hospital. If your fever has not come down after 2 to 3 days of antibiotic treatment, you should be checked again and may need to be admitted to hospital.
Key points
Key guideline recommendations
- Level of evidence not stated in the abstract
Clinical judgement is recommended to determine which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the MASCC (Multinational Association of Supportive Care in Cancer) risk index. Psychosocial and logistic considerations should also be taken into account.
- Consensus recommendation (endorsed from the previous version)
Patients with febrile neutropenia should receive the first doses of empirical antibacterial therapy within 1 hour of triage and should be monitored for at least 4 hours before discharge.
- Level of evidence not stated in the abstract
An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin if allergic to penicillin) is recommended as outpatient empirical therapy, unless fluoroquinolone prophylaxis was used before the onset of fever.
- Level of evidence not stated in the abstract
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.
Study population
Adults with cancer receiving treatment for malignancy who develop fever and neutropenia (a low neutrophil count) and are being assessed for outpatient management.
Endpoints
This document is a clinical practice guideline and has no trial endpoint. Its subject is identifying patients who can be managed as outpatients, as well as outpatient empirical therapy and the timing of monitoring and reassessment.
Safety and side effects
The published abstract gives no information on rates of grade ≥ 3 adverse events. See the full guideline for safety details.
Clinical significance and place in guidelines
This guideline is a joint ASCO and IDSA update and provides a framework for selecting patients suitable for outpatient management: clinical judgement, clinical criteria or a validated tool such as the MASCC index, along with psychosocial and logistic considerations. It stresses that the first dose of empirical antibacterial therapy should be given within 1 hour of triage and that the patient should be monitored for at least 4 hours before discharge. The suggested outpatient regimen is an oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin in penicillin allergy), except in patients who received fluoroquinolone prophylaxis before the fever. The current status of the guideline and newer versions should be checked in official ASCO and IDSA sources.
Limitations
The published abstract does not report the level of evidence or strength of the recommendations, exact drug doses or quantitative study results. These must be taken from the full guideline. The recommendations are based on review of the evidence by an expert panel, and some rest on consensus.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.