Outpatient therapy for febrile neutropenia

The management of febrile neutropenia has evolved significantly with the development of risk stratification and recognition of the efficacy of oral antibiotics in low-risk patients. There remains uncertainty concerning the need for hospitalization and role of early hospital discharge. We review recent evidence in this field and identify outstanding issues for future research.

Studies have confirmed the utility of the MASCC risk index. Preliminary findings suggest that early hospital discharge is feasible in low-risk patients with solid tumours and lymphomas, at least in specialist centres. Median hospital stays may be reduced to 48 h with no increase in serious medical complications. Readmission rates remain low.

All patients with febrile neutropenia should undergo risk stratification on admission, and low-risk patients should be considered eligible for combination oral antibiotics from the outset. Those patients who show signs of fever resolution and subjective improvement are eligible for early discharge. More research is required with regard to patients with haematological malignancies and/or receiving prophylactic antibiotics, and in the development of factors predictive of successful early discharge. Further data are required regarding whether strategies involving early discharge can be safely implemented at centres outside those which have pioneered these approaches.