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Infectious DiseaseEmergency

Febrile Neutropenia Management (IDSA/ASCO 2018)

Febrile Neutropenia Management (IDSA/ASCO 2018): Febrile Neutropenia → Immediate Assessment → Empiric Antibiotics Within 1h → MASCC Risk Score → Low Ris...

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Febrile Neutropenia

    Temp ≥38.3°C + ANC <500

    1. ●
      Action

      Immediate Assessment

      Blood cultures x2, CBC, BMP, CXR

      • Do NOT delay antibiotics
      1. ●
        Action

        Empiric Antibiotics Within 1h

        Antipseudomonal monotherapy

        • Cefepime 2g IV q8h OR
        • Pip-tazo 4.5g IV q6h OR
        • Meropenem 1g IV q8h
        1. ◆
          Decision

          MASCC Risk Score

          ≥21 = Low risk

          1. ●
            Action

            Low Risk (MASCC ≥21)

            Outpatient possible

            • Cipro + Augmentin PO
            • Observe ≥4h
            1. ◆
              Decision

              Reassess 48-72h

              Culture results, clinical response

              1. ●
                Action

                Responding

                Continue/narrow therapy

                1. ●
                  Action

                  Duration

                  Until ANC ≥500 + afebrile 48h

                  1. ✓
                    Outcome

                    Resolved

                  2. ⚠
                    Warning

                    Complications/Death

              2. ●
                Action

                Persistent Fever 4-7d

                Add empiric antifungal

                • Caspofungin, Micafungin, or Ampho B
              3. ⚠
                Warning

                Deteriorating

                Broaden coverage, ICU

          2. ●
            Action

            High Risk (MASCC <21)

            Inpatient IV therapy

            • Continue IV beta-lactam
            1. ◆
              Decision

              Add Vancomycin?

              Not routine

              • Only if: Hemodynamic instability, line infection, skin/ST infection, MRSA

Guideline Source

ASCO/IDSA Clinical Practice Guideline for Outpatient Management of Fever and Neutropenia

DOI: 10.1200/JCO.2017.77.6211View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • MASCC score may not capture all risk factors
  • Local resistance patterns guide empiric therapy
  • Fungal coverage timing varies by institution

Applicable Regions

USEU
Version 1Next review: 2027-01-11

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Frequently Asked Questions

What is the Febrile Neutropenia Management (IDSA/ASCO 2018)?

The Febrile Neutropenia Management (IDSA/ASCO 2018) is a emergency clinical algorithm for Infectious Disease. It provides a structured decision tree to guide clinical decision-making, based on ASCO/IDSA Clinical Practice Guideline for Outpatient Management of Fever and Neutropenia.

What guideline is the Febrile Neutropenia Management (IDSA/ASCO 2018) based on?

This algorithm is based on ASCO/IDSA Clinical Practice Guideline for Outpatient Management of Fever and Neutropenia (DOI: 10.1200/JCO.2017.77.6211).

What are the limitations of the Febrile Neutropenia Management (IDSA/ASCO 2018)?

Known limitations include: MASCC score may not capture all risk factors; Local resistance patterns guide empiric therapy; Fungal coverage timing varies by institution. Individual patient factors may require deviation from these recommendations.

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