National guidelines are urgently neededBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d449 (Published 25 January 2011) Cite this as: BMJ 2011;342:d449
- Michael A Przybylo, specialty trainee (StR1) in medical microbiology at the Northwest Deanery1,
- Achyut Guleri, consultant microbiologist1,
- Rashmi Sharma, consultant microbiologist1,
- Ruth Palmer, consultant microbiologist1
- 1Department of Clinical Microbiology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool FY3 8NR, UK
Febrile neutropenia is a medical emergency that is associated with morbidity and mortality if not managed appropriately with urgency.1 Guidelines define fever as either a single oral temperature of 38.3°C or 38.0°C for one hour and neutropenia as a neutrophil count ≤0.5×109/L or ≤1.0×109/L, with a predicted decrease to ≤0.5×109/.2 3
Christie Hospital guidelines stratify risk on the basis of counts <1.0×109/L, <0.5×109/L, and <0.01×109/L and suggest applying this stratification only at specialist centres.3 The Department of Health (DoH) report and practice at most specialist units offering chemotherapy include a treatment plan and patient information on side effects, helpline numbers, and a facility for direct admission to the unit.4 Data from the National Confidential Enquiry into Patient Outcome and Death suggest that high risk patients are not optimally informed.5 Diagnosis of febrile neutropenia requires rapid performance of a full blood count, and DoH guidance mandates administration of intravenous broad spectrum antibiotics within one hour. Timely and specialist clinical assessment and prompt management of high risk patients would be suboptimal in primary care.
The DoH report (2009) requested that the National Institute for Health and Clinical Excellence urgently develop a national guideline on the clinical management and prevention of febrile neutropenia,4 but this is still awaited. A regional re-audit (2010) on the management of febrile neutropenia across 17 hospitals reported considerable variation, in the absence of national guidance that would apply to district hospitals and specialist centres.
Cite this as: BMJ 2011;342:d449
Competing interests: None declared.