A patient with neutropenia following chemotherapy presents with fever of 38.3 C (101 F). What is the priority action?

• A. Observe at home and call if fever persists.
• B. Begin antipyretics and monitor.
• C. Follow neutropenic fever protocol: obtain cultures and initiate empiric broad-spectrum antibiotics after provider order; monitor closely.
• D. Delay antibiotics until culture results confirm infection.

Answer: (C)

Fever in a patient with chemotherapy-induced neutropenia is a medical emergency because the immune system is severely compromised, and infections can progress quickly without typical inflammatory signs. The priority action is to activate the neutropenic fever protocol: obtain blood cultures (and any other indicated cultures) and start empiric broad-spectrum IV antibiotics promptly, after a provider orders them, with close monitoring. Cultures are important to identify the culprit and tailor therapy, but treatment should not be delayed while waiting for results. Administering empiric antibiotics quickly reduces mortality risk in neutropenic fever. After starting therapy, continue vigilant monitoring for signs of clinical improvement or deterioration and adjust management based on culture results and patient status. Delaying antibiotics or opting to treat only with antipyretics or at-home observation would miss the critical window to control a potentially life-threatening infection.