Key priorities for implementation

Guidance

The following recommendations have been identified as priorities for implementation.

Provide patients having anticancer treatment and their carers with written and oral information, both before starting and throughout their anticancer treatment, on:
- neutropenic sepsis
- how and when to contact 24-hour specialist oncology advice
- how and when to seek emergency care.

For adult patients (aged 18 years and older) with acute leukaemias, stem cell transplants or solid tumours in whom significant neutropenia (neutrophil count 0.5×10⁹ per litre or lower) is an anticipated consequence of chemotherapy, offer prophylaxis with a fluoroquinolone during the expected period of neutropenia only. Follow the MHRA safety advice on fluoroquinolone antibiotics. At the time of review (November 2019), fluoroquinolone antibiotics did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

Treat suspected neutropenic sepsis as an acute medical emergency and offer empiric antibiotic therapy immediately.
Include in the initial clinical assessment of patients with suspected neutropenic sepsis:
- history and examination
- full blood count, kidney and liver function tests (including albumin),
  C-reactive protein, lactate and blood culture.

Offer beta lactam monotherapy with piperacillin with tazobactam as initial empiric antibiotic therapy to patients with suspected neutropenic sepsis who need intravenous treatment unless there are patient-specific or local microbiological contraindications. At the time of publication (September 2012) piperacillin with tazobactam did not have a UK marketing authorisation for use in children aged under 2 years. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The child's parent or carer should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing medicines – guidance for doctors and the prescribing advice provided by the Joint Standing Committee on Medicines (a joint committee of the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group) for further information.
Do not offer an aminoglycoside, either as monotherapy or in dual therapy, for the initial empiric treatment of suspected neutropenic sepsis unless there are patient-specific or local microbiological indications.

Diagnose neutropenic sepsis in patients having anticancer treatment whose neutrophil count is 0.5×10⁹ per litre or lower and who have either:
- a temperature higher than 38^oC or
- other signs or symptoms consistent with clinically significant sepsis.

A healthcare professional with competence in managing complications of anticancer treatment should assess the patient's risk of septic complications within 24 hours of presentation to secondary or tertiary care, basing the risk assessment on presentation features and using a validated risk scoring system.

Consider outpatient antibiotic therapy for patients with confirmed neutropenic sepsis and a low risk of developing septic complications, taking into account the patient's social and clinical circumstances and discussing with them the need to return to hospital promptly if a problem develops.

Offer discharge to patients having empiric antibiotic therapy for neutropenic sepsis only after:
- the patient's risk of developing septic complications has been reassessed as low by a healthcare professional with competence in managing complications of anticancer treatment using a validated risk scoring system and
- taking into account the patient's social and clinical circumstances and discussing with them the need to return to hospital promptly if a problem develops.