From the Guidelines
Patients with febrile neutropenia can be discharged when they have been afebrile for at least 24 hours, show clinical improvement, have a rising neutrophil count (typically ANC >500 cells/mm³), and can tolerate oral medications, as supported by the most recent and highest quality study 1.
Discharge Criteria
The discharge criteria for patients with febrile neutropenia include:
- Being afebrile for at least 24 hours after stopping intravenous antibiotics and fluconazole
- Having an ANC >500 cells/mm³ and trending upward
- Having a platelet count >20,000/mm³ independent of transfusion
- Being able to safely perform activities of daily living
- Having a feasible plan for managing any ongoing toxicity as an outpatient
- Having close follow-up and coordination of care, with the ability to return promptly if symptoms recur
Antibiotic Therapy
For patients who will complete antibiotic therapy as outpatients, oral options include fluoroquinolones (such as ciprofloxacin 500-750 mg twice daily) plus amoxicillin-clavulanate (875/125 mg twice daily), or a suitable alternative based on culture results and antimicrobial susceptibility, as recommended by 1.
Follow-up Care
Close follow-up within 2-3 days of discharge is recommended, and patients should be provided with all the necessary contact information for their care team, so they are aware of who needs to be contacted in case of any complications or emergencies, as suggested by 1.
General Considerations
It is essential to prioritize the patient's safety and well-being, ensuring that they have reliable access to healthcare, good medication adherence, and the ability to manage any ongoing toxicity as an outpatient, as emphasized by 1.
From the Research
Discharge Criteria for Febrile Neutropenia
The discharge criteria for patients with febrile neutropenia include:
- Being afebrile for a certain period, typically 24-48 hours 2, 3, 4, 5
- Having negative blood cultures 2, 3, 4, 5
- Appearing clinically stable and well 2, 3, 5
- Having evidence of bone marrow recovery 2, 3, 5
- Having an absolute neutrophil count (ANC) that may not necessarily need to exceed 500 cells/mm^3 for discharge 2, 3, 6, 5
Patient Risk Factors
Certain patient factors can influence the decision to discharge, including:
- A declining ANC, which may indicate a higher risk of recurrent fever 2
- Advanced malignancy, which can also increase the risk of complications 2
- Acute lymphoblastic leukemia, which may be associated with a higher risk of readmission for fever 3
- An ANC of ≤100 cells/mm^3 at discharge, which can increase the risk of significant infection 3
Safety and Efficacy of Early Discharge
Studies have shown that early discharge of low-risk patients with febrile neutropenia can be safe and effective, with acceptable rates of readmission and subsequent infection 2, 3, 6, 5. However, careful selection of patients and close monitoring for signs of clinical deterioration are crucial to ensure patient safety 6.