Initial management of febrile episode

(Temperature above 38 degrees C on 2 readings taken 2 hours apart or 1 reading if the patient is clearly unwell)

(1) history and examination to establish the septic focus. Chest X-ray should be performed within 24 hours.

(2) Take cultures prior to commencing antibiotics:

• blood cultures (at least one peripheral set plus one set from Hickman line if present).
• mouth/throat swab if indicated.
• stool culture.
• MSU
• sputum (if any)

(3) adress problems of anaemic, thrombocytopaenia and dehydration if relevant.

(4) start broad-spectrum intravenous antibiotics:

• empirical treatment is generally a broad-spectrum penicillin or cephalosporin with antipseudomonal activity (e.g. ceftazidine or azlocillin) in combination with an aminoglycoside
• there has been a move towards the use of monotherapy in recent years e.g. using ceftazidine, imipenem, cefipime - this is a reasonable approach in patients with uncomplicated febrile neutropaenia