This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

This article, prepared by the Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guidelines Panel, updates guidelines established a decade ago by the Infectious Disease Society of America for the use of antimicrobial agents to treat neutropenic patients with unexplained fever [1]. DefinitionsFever is defined as a single oral temperature of у38.3ЊC (101ЊF) or a temperature of у38.0ЊC (100.4ЊF) for у1 h. Neutropenia is defined as a neutrophil count of !500 cells/mm 3 , or a count of !1000 cells/mm 3 with a predicted decrease to !500 cells/mm 3 . Initial EvaluationDetermine whether the patient is at low risk for complications; determine whether vancomycin therapy is needed. Initial Antibiotic TherapyOral route. For low-risk adults only; use ciprofloxacin plus amoxicillin-clavulanate.Monotherapy with vancomycin not indicated.

The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective.