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Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications

Eric Bow, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


Cancer patients receiving cytotoxic antineoplastic therapy sufficient to adversely affect myelopoiesis and the developmental integrity of the gastrointestinal mucosa are at risk for invasive infection due to colonizing bacteria or fungi that translocate across intestinal mucosal surfaces. Since the magnitude of the neutrophil-mediated component of the inflammatory response may be muted in neutropenic patients [1], an elevated body temperature may be the earliest and only sign of infection. It is critical to recognize neutropenic fever and associated sepsis syndromes early and to initiate empiric systemic antibacterial therapy promptly in order to avoid progression to a sepsis syndrome and possibly death.

The treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications will be reviewed here. The treatment and prevention of neutropenic fever in adults at high risk for complications are discussed separately. An overview of neutropenic fever syndromes, the risk assessment of patients with neutropenic fever, the diagnostic approach to patients presenting with neutropenic fever, and the use of colony stimulating factors in patients with chemotherapy-induced neutropenia are also discussed elsewhere. (See "Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients)" and "Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults" and "Prophylaxis of invasive fungal infections in adults with hematologic malignancies" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients" and "Prevention of infections in hematopoietic cell transplant recipients" and "Overview of neutropenic fever syndromes" and "Risk assessment of adults with chemotherapy-induced neutropenia" and "Diagnostic approach to the adult presenting with neutropenic fever" and "Use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation".)

Neutropenic fever in children is also presented separately. (See "Fever in children with chemotherapy-induced neutropenia".)


Guidelines have been developed for the prevention and management of fever in neutropenic patients with cancer [2-8]. The recommendations below are generally in keeping with the 2010 Infectious Diseases Society of America (IDSA) guidelines [2] and the 2013 American Society of Clinical Oncology (ASCO) guidelines [7].

It should be noted that our approach differs slightly from the approach of the IDSA and ASCO because we consider low-risk patients to be those who are anticipated to have an absolute neutrophil count <500 cells/microL (rather than <100 cells/microL) for ≤7 days. The rationale for choosing this threshold is discussed below. (See 'Risk of serious complications' below.)


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Literature review current through: Sep 2016. | This topic last updated: Dec 8, 2015.
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