In a neutropenic patient, what do the UK NICE (NG33) and Australian Therapeutic Guidelines recommend for defining fever and initiating empiric antibiotics?

UK NICE and Australian Guidelines for Febrile Neutropenia

The provided evidence does not include UK NICE (NG33) or Australian Therapeutic Guidelines, so I cannot provide their specific recommendations for defining fever and initiating empiric antibiotics in neutropenic patients.

What the Available Guidelines Show

The evidence base consists primarily of US-based IDSA guidelines and related international consensus documents. Here's what these established guidelines recommend:

Fever Definition (US/International Standards)

• Fever is defined as a single oral temperature of ≥38.3°C (101°F) OR a temperature of ≥38.0°C (100.4°F) sustained over 1 hour 1, 2
• Neutropenia is defined as an absolute neutrophil count (ANC) <500 cells/mm³, or <1000 cells/mm³ with predicted decline to <500 cells/mm³ 1, 2

Timing of Antibiotic Initiation

• Empiric antibiotics must be initiated within 2 hours of presentation, as infection can progress rapidly in neutropenic patients and urgent administration significantly improves outcomes 3, 2
• Blood cultures and diagnostic studies should be obtained concurrently with or after antibiotic initiation, not before—do not delay antibiotics to obtain cultures first 3

Empiric Antibiotic Selection

For high-risk patients (including recent chemotherapy within 2 weeks):

• IV monotherapy with an anti-pseudomonal β-lactam is recommended: cefepime, meropenem, piperacillin-tazobactam, or ceftazidime 1, 3
• Vancomycin should NOT be routinely added unless specific indications exist: hemodynamic instability, suspected catheter-related infection, severe mucositis, or known MRSA colonization 1, 3

For low-risk patients:

• Oral therapy with ciprofloxacin plus amoxicillin-clavulanate may be considered for carefully selected patients with no focus of infection, no systemic symptoms, and reliable outpatient follow-up 1

Important Caveats

• Rectal examinations and rectal temperatures must be avoided during neutropenia due to risk of bacterial translocation 3
• Classic signs of inflammation (redness, swelling, purulence) may be absent in neutropenic patients—fever may be the only sign of infection 2
• The majority of neutropenic fever episodes have no identifiable source despite thorough evaluation 2

Regarding UK and Australian Guidelines

To obtain the specific recommendations from UK NICE NG33 and Australian Therapeutic Guidelines, you would need to access those documents directly, as they are not included in this evidence set. However, international guidelines generally align on the core principles of fever definition (≥38.3°C single reading or ≥38.0°C sustained) and urgent antibiotic initiation (within 2 hours), though specific antibiotic choices may vary based on local resistance patterns.