# Febrile neutropenia

Source: [[../policies/POL-CW-01-febrile-neutropenia.md|POL-CW-01]] v3.1 (12 Mar 2024) · Owner: Infectious Diseases · Ages **0–18**

Teaching copy. Not KHCC policy. Not for real patients.

## The rules as written

- Fever = 38.3°C once, or 38.0°C for one hour.
- Neutropenia = ANC **< 500/µL**. Treat as FN if on chemo and unwell, even before the count.
- Come to **ER the same evening**. No waiting for morning clinic. No paracetamol at home before assessment.
- Door-to-antibiotic: **60 minutes**. Cultures, then the first dose.
- Peripheral culture **first**, then every lumen.
- First-line: **piperacillin-tazobactam**. Add gentamicin if high-risk. Penicillin rash → **cefepime**. Not ceftriaxone.
- After cultures, antibiotics may run through the line. No heparin lock as part of this pathway.
- Neutropenic visitors: **two named caregivers only**. No children under 12.

## Linked notes

- [[central-line]] — disagrees on age, ANC cut-off, culture order, first-line drugs, and whether to wait for the attending.
- [[visitor-isolation]] — disagrees on how many adult visitors are allowed.
- [[discharge-fever]] — **dangerous disagreement**: the leaflet tells families to wait until morning.
- [[chemo-safety]] — night fever after an infusion is sent to the day unit, not ER.

## Open questions

- v3.1 is past its March 2026 review date.
- POL-CW-01 says the discharge leaflet “must” match this pathway. POL-CW-05 does not.