Supportive Care in Cancer

, Volume 16, Issue 2, pp 181–191

Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA

  • Alison Freifeld
  • Jayashri Sankaranarayanan
  • Fred Ullrich
  • Junfeng Sun
Original Article

DOI: 10.1007/s00520-007-0308-x

Cite this article as:
Freifeld, A., Sankaranarayanan, J., Ullrich, F. et al. Support Care Cancer (2008) 16: 181. doi:10.1007/s00520-007-0308-x



The purpose of the study was to determine oncologists’ current practice patterns for antibiotic management of low-risk fever and neutropenia (FN) after chemotherapy.

Materials and methods

A self-administered survey was developed to query management practices for low-risk FN patients and sent to 3,600 randomly selected American Society of Clinical Oncology physician members; hypothetical case scenarios were included to assess factors influencing decisions about outpatient treatment.


Of 3,560 actively practicing oncologists, 1,207 replied (34%). Outpatient antibiotics are used by 82% for selected low-risk FN patients (27% used in them >65% of their patients). Oral levofloxacin (50%), ciprofloxacin (36%), and ciprofloxacin plus amoxicillin/clavulanate (35%) are common outpatient regimens. Fluoroquinolone prophylaxis is used by 45% of oncologists, in a subset of afebrile patients at low risk for FN; growth factors are used adjunctively by 48% for treating low-risk FN. Factors associated with choosing outpatient treatment were: frequency of use in oncologists’ own practices, absence of hematologic malignancy, lower patient age, no infiltrate on X-ray, no prior serious infection, shorter expected FN duration, lower creatinine levels, and shorter distance of patient’s residence from the hospital.


US oncologists, who responded are willing to prescribe outpatient oral antibiotic treatment for low-risk FN, although practices vary considerably and are based on favorable clinical factors. However, practices are often employed that are not recommended for low-risk patients by current guidelines, including fluoroquinolone prophylaxis, adjunctive and/or prophylactic growth factors, and use of levofloxacin for empiric therapy. Educational efforts are needed to better guide cost-effective and supportive care.


CancerChemotherapyEmpiric antibiotic treatmentFeverLow riskNeutropenia

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Alison Freifeld
    • 1
    • 5
  • Jayashri Sankaranarayanan
    • 2
  • Fred Ullrich
    • 3
  • Junfeng Sun
    • 4
  1. 1.Department of MedicineUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of Pharmacy Practice, College of PharmacyUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  4. 4.Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  5. 5.Immunocompromised Host Infectious Diseases ProgramUniversity of Nebraska Medical CenterOmahaUSA