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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...

Pathway Overview

14 steps

Algorithm Steps

14 total

  1. 01Start

    Febrile Neutropenia

    Temp ≥38.3°C + ANC <500

  2. 02Action

    Immediate Assessment

    Blood cultures x2, CBC, BMP, CXR

    • Do NOT delay antibiotics
  3. 03Action

    Empiric Antibiotics Within 1h

    Antipseudomonal monotherapy

    • Cefepime 2g IV q8h OR
    • Pip-tazo 4.5g IV q6h OR
    • Meropenem 1g IV q8h
  4. 04Decision

    MASCC Risk Score

    ≥21 = Low risk

  5. 05Action

    Low Risk (MASCC ≥21)

    Outpatient possible

    • Cipro + Augmentin PO
    • Observe ≥4h
  6. 06Decision

    Reassess 48-72h

    Culture results, clinical response

  7. 07Action

    Responding

    Continue/narrow therapy

  8. 08Action

    Duration

    Until ANC ≥500 + afebrile 48h

  9. 09Outcome

    Resolved

  10. 10Warning

    Complications/Death

  11. 11Action

    Persistent Fever 4-7d

    Add empiric antifungal

    • Caspofungin, Micafungin, or Ampho B
  12. Path rejoins step 08Shared downstream outcome
  13. 12Warning

    Deteriorating

    Broaden coverage, ICU

  14. Path rejoins step 08Shared downstream outcome
  15. 13Action

    High Risk (MASCC <21)

    Inpatient IV therapy

    • Continue IV beta-lactam
  16. 14Decision

    Add Vancomycin?

    Not routine

    • Only if: Hemodynamic instability, line infection, skin/ST infection, MRSA
  17. Path rejoins step 06Shared downstream outcome

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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