A cancer patient with febrile neutropenia is evaluated after the first 3 to 5 days of empiric therapy. If the patient is still febrile then changes to the regimen may be necessary. The authors are from the Infectious Diseases Society of America (IDSA) and multiple hospitals in the North America and Europe.



(1) clinical condition unchanged or deteriorating

(2) currently receiving vancomycin

(3) currently has indications to receive vancomycin

(4) etiology of infection identified

(5) status of neutropenia


If the patient is receiving vancomycin and there are no longer any indications, then it should be stopped.


If the patient is not receiving vancomycin and there are now indications to receive it, then it should be started.


If the patient's condition is unchanged and if there is no reason to change the drug regimen (based on identification of the cause of the fever), then continue the same antibiotics.


If the patient's condition has deteriorated then change antibiotics. If the cause of the fever has been identified use this information to guide selection of the new regimen.


If the fever persists and the neutropenia is expected to persist, then consider adding an antifungal agent.


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