Managing neutropenic sepsisBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3960 (Published 29 September 2009) Cite this as: BMJ 2009;339:b3960
- S Michael Crawford, consultant medical oncologist1
The fever of flu may mimic neutropenic fever. Therefore a policy for managing fever during the A/H1N1 flu pandemic in patients with cancer who are receiving chemotherapy has been developed with detailed advice from Professor Nick Phin and Dr Hongxin Zhao of the Health Protection Agency.
Patients receiving chemotherapy who develop a fever should telephone the emergency number of their haematology or oncology unit for advice, not the National Pandemic Flu Service.1
If assessed in hospital, patients should wear a surgical mask and be seen in a single room by healthcare professionals using personal protective equipment. A virological swab should be taken and biochemical tests ordered in addition to the usual tests. Other identified causes of fever with a normal or raised neutrophil count should be treated as appropriate.
Patients who are not neutropenic and may have flu should be sent home with a course of oseltamivir, given at the point of contact with the hospital and with advice to self isolate and to take general respiratory and personal hygiene measures.
Patients with neutropenia should be admitted with institution of infection control measures. The microbiologist should be informed, and the neutropenia treated according to the usual protocol with the addition of oseltamivir.
Patients with laboratory confirmed A/H1N1 pandemic flu whose condition does not improve or deteriorates with antiviral treatment should telephone their unit’s emergency telephone number. They should attend for reassessment, including a repeat blood count, cultures, and a viral swab. Some of the material should be sent to a laboratory that can detect antiviral resistance. Zanamivir by inhalation should be considered after consultation with a microbiologist or virologist, whether or not the patient is neutropenic.
Cite this as: BMJ 2009;339:b3960
Competing interests: None declared.