{"entity":{"id":"febrile-neutropenia-first-hour","kind":"protocol","name":"Suspected febrile neutropenia (neutropenic sepsis): the first hour","aka":["neutropenic sepsis first hour","febrile neutropenia door-to-needle","neutropenic fever emergency management","suspected neutropenic sepsis"],"tldr":"Anyone having cancer treatment who feels unwell, with or without a high temperature, should ring their 24-hour cancer line and be seen in hospital straight away. There they should be given a strong antibiotic through a drip within about an hour, without waiting for the blood count to come back.","summary":"Suspect neutropenic sepsis in any adult having anticancer treatment who becomes unwell (NICE CG151 1.3.1.1); NICE NG253 widens this to systemic anticancer treatment within the last 30 days and to people on immunosuppressants, and warns that people having treatment for cancer may not develop a raised temperature. NICE confirms the diagnosis later, at a neutrophil count of 0.5 × 10⁹/L or lower with a temperature higher than 38 °C or other signs of clinically significant sepsis; SEOM uses a temperature above 38 °C or clinical signs of sepsis with neutrophils below 500/mm³, or below 1000/mm³ before the nadir.\n\nTreatment does not wait for the count. NICE says to offer empiric antibiotics immediately and sets no clock, because its committee found the evidence on timing very low quality; ASCO/IDSA (2018) endorse the first dose within 1 hour of triage, and SEOM (2018) within the first hour of arrival in the emergency department, after cultures. NICE's first choice is piperacillin with tazobactam alone, with no routine aminoglycoside or glycopeptide; SEOM allows any anti-pseudomonal beta-lactam and adds amikacin, preferably with a carbapenem, when severity criteria are met. Bloods include full blood count, renal and liver function with albumin, C-reactive protein, lactate and blood cultures, with a peripheral culture as well as a line culture where there is a central venous device, which stays in.\n\nWithin 24 hours a competent clinician scores the risk of septic complications with a validated tool (MASCC; CISNE for stable patients with solid tumours on moderate-intensity chemotherapy in SEOM). A MASCC score of 21 or more marks those who may go home on oral antibiotics; under 21 is high risk and stays on the standard pathway. Under NG253, a high-risk patient who does not respond within 1 hour of any intervention needs a senior decision maker in person and a critical care discussion.","asOf":"2026-11-11","links":[],"tags":["protocol","neutropenic-sepsis","acute-oncology"],"related":["idea-acc-hospital-at-home-oncology","idea-acc-acute-oncology-assessment-units"],"cancers":[],"sections":["supportive-care"],"technologies":["implanted-ports","picc-lines"],"targets":[],"drugs":[],"companies":[],"institutions":["nice","asco","mascc"],"pathways":[],"terms":["febrile-neutropenia","neutropenia","central-venous-access","neutropenic-sepsis-breast-chemotherapy"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"simple":"Cancer medicines can lower the white cells that fight germs. If you feel ill during treatment, even without a fever, ring your cancer helpline at once. The hospital should give you antibiotics quickly, usually within an hour.","domain":"emergencies","setting":{"who":["patient-or-carer","nurse","doctor","emergency-team"],"where":["home","telephone-triage","emergency-department","acute-oncology-service","ward"]},"population":"Adults having anticancer treatment, chemotherapy above all, who become unwell or have a fever. NICE CG151 covers people of any age with age-specific recommendations marked; this protocol follows its adult recommendations and NG253, which covers people aged 16 or over. Children, and people after stem cell transplant or with acute leukaemia where local haematology protocols differ, are not covered here.","trigger":"A person having anticancer treatment (NICE NG253: systemic anticancer treatment within the last 30 days) becomes unwell, with or without a temperature above 38 °C.","steps":[{"action":"Before treatment starts, give the patient and carer written and spoken information on neutropenic sepsis and the 24-hour number","why":"Most episodes start at home between visits, so the person needs to know the signs and whom to ring before they need to.","source":"nice-cg151","quote":"Provide patients having anticancer treatment and their carers with written and oral information, both before starting and throughout their anticancer treatment, on:"},{"action":"On the phone or at the door, suspect neutropenic sepsis in anyone having anticancer treatment who is unwell","why":"The trigger is feeling unwell during treatment, not a number on a thermometer.","source":"nice-cg151","quote":"Suspect neutropenic sepsis in patients having anticancer treatment who become unwell."},{"action":"Do not rule sepsis out because the temperature is normal","why":"People having cancer treatment may be septic without a raised temperature, and steroids or paracetamol can hide one.","source":"nice-ng253","quote":"Do not rely on fever or hypothermia alone to rule sepsis either in or out."},{"action":"Send the person to hospital at once; do not book a routine appointment","why":"Assessment and the first antibiotic happen in hospital, so any delay at the telephone stage adds to the time before treatment.","source":"nice-cg151","quote":"Refer patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care."},{"action":"Treat it as an emergency on arrival and start empiric intravenous antibiotics immediately","why":"Without neutrophils an infection can spread fast, and the antibiotic is the one step that changes the outcome.","source":"nice-cg151","quote":"Treat suspected neutropenic sepsis as an acute medical emergency and offer empiric antibiotic therapy immediately."},{"action":"Give the first dose within one hour of arrival, and record when the clock started","why":"The one-hour target is the one most guidelines and audits use; writing down the start time is what lets a team see whether it was met.","source":"seom-2018","quote":"Empirical antibiotic therapy should be initiated within the first hour of arrival at the ED (after sampling for cultures)","grade":"II, A"},{"action":"Do not wait for the neutrophil count before giving the antibiotic","why":"NICE's antibiotic recommendation applies to suspected neutropenic sepsis; the count is used afterwards to confirm the diagnosis (CG151 1.4.4.1), not to decide the first dose.","source":"nice-cg151"},{"action":"Take a history, examine, and send full blood count, kidney and liver tests with albumin, C-reactive protein, lactate and blood cultures","why":"These find the likely source and show how unwell the person is, which decides the next steps.","source":"nice-cg151"},{"action":"Take two sets of blood cultures before the antibiotic, inside the hour, plus other samples the history points to","why":"Cultures taken after the first dose are less likely to grow the germ, but taking them must not push the antibiotic past the hour.","source":"seom-2018","quote":"Two pairs of blood cultures and microbiological specimens, as clinically indicated, should be obtained prior to initiating empirical antibiotic therapy","grade":"III, A"},{"action":"If there is a central line, port or PICC, take a peripheral culture as well and leave the line in","why":"A second culture from a vein helps show whether the line is the source; taking the line out is not part of the first hour.","source":"nice-cg151","quote":"Do not remove central venous access devices as part of the initial empiric management of suspected neutropenic sepsis."},{"action":"Give piperacillin with tazobactam on its own as the first antibiotic, unless allergy or local resistance rules it out","why":"NICE's analysis found lower mortality and less kidney harm with this single drug than with a carbapenem or with an added aminoglycoside.","source":"nice-cg151","quote":"Offer beta lactam monotherapy with piperacillin with tazobactam as initial empiric antibiotic therapy to patients with suspected neutropenic sepsis who need intravenous treatment unless there are patient-specific or local microbiological contraindications."},{"action":"Do not add an aminoglycoside or a glycopeptide routinely","why":"NICE limits them to patient-specific or local microbiological reasons, such as a line infection or known resistant organisms.","source":"nice-cg151","quote":"Do not offer an aminoglycoside, either as monotherapy or in dual therapy, for the initial empiric treatment of suspected neutropenic sepsis unless there are patient-specific or local microbiological indications."},{"action":"Do a chest X-ray only if the history or examination points to the chest","why":"NICE found no reason to X-ray every patient; SEOM includes one in the first assessment (see variants).","source":"nice-cg151","quote":"Do not perform a chest X-ray unless clinically indicated."},{"action":"If a high-risk patient has not responded within an hour of any intervention, get the senior decision maker in person and talk to critical care","why":"Failure to respond to antibiotics and fluids in the first hour is the point to bring in intensive care, not after a further wait.","source":"nice-ng253","quote":"If a person aged 16 years or over who is at high risk of severe illness or death from sepsis does not respond within 1 hour of any intervention:"},{"action":"Within 24 hours, have a competent clinician score the risk of complications with a validated tool such as MASCC","why":"The score separates people who can finish treatment at home from those who need to stay in hospital.","source":"nice-cg151","quote":"A healthcare professional with competence in managing complications of anticancer treatment should assess the patient's risk of septic complications within 24 hours of presentation to secondary or tertiary care, basing the risk assessment on presentation features and using a validated risk scoring system."},{"action":"Treat a MASCC score under 21 as high risk on the standard inpatient pathway, and consider 21 or more for outpatient care","why":"In the original validation a score of 21 or more picked out low-risk patients with a positive predictive value of 91 per cent.","source":"mascc-2026","quote":"Patients treated with chemotherapy/ICI presenting with febrile neutropenia and a MASCC risk index < 21 are high risk and require standard neutropenic sepsis management.","grade":"A"},{"action":"For outpatient treatment, give the first dose intravenously within the hour, observe for at least 4 hours, then switch to oral antibiotics","why":"The observation period catches people who look well at first but are not; ASCO/IDSA name an oral fluoroquinolone with amoxicillin and clavulanate unless a fluoroquinolone was already being taken as prevention.","source":"seom-2018","quote":"In low-risk patients for whom ambulatory treatment has been decided on, the first dose of antibiotic should be administered via IV within the first hour and the patient should remain in observation at the hospital for at least 4 h","grade":"III, B"}],"bestInClass":{"statement":"Start empiric intravenous antibiotics on suspicion, without waiting for the neutrophil count. On timing the guidelines differ in wording and in where the clock starts: NICE CG151 says immediately and sets no clock, judging the evidence too weak to name a period while noting the one-hour pathway of the National Cancer Peer Review Programme; ASCO/IDSA (2018) endorse the first dose within 1 hour of triage; SEOM (2018) within the first hour of arrival in the emergency department, after cultures. NICE NG253 times its general sepsis antibiotic from the NEWS2 score at initial assessment but sends neutropenic sepsis back to CG151. On the trigger, NICE confirms the diagnosis at neutrophils of 0.5 × 10⁹/L or lower with a temperature higher than 38 °C or other signs of clinically significant sepsis, and both NICE guidelines warn that people having cancer treatment may not run a temperature; SEOM uses above 38 °C or clinical signs of sepsis with neutrophils below 500/mm³, or below 1000/mm³ before the nadir. On the first drug, NICE recommends piperacillin with tazobactam alone; SEOM allows any anti-pseudomonal beta-lactam (piperacillin with tazobactam, meropenem, imipenem with cilastatin or cefepime) and adds amikacin when severity criteria are met. Risk scoring with MASCC (score of 21 or more is low risk) or, for stable patients with solid tumours, CISNE then decides who can continue at home.","sources":["nice-cg151","nice-cg151-full","nice-ng253","asco-idsa-2018","seom-2018","mascc-2026"]},"variants":[{"name":"Clock started at presentation, with nurse-given first dose (Cardiff and Vale University Health Board)","differs":"Sets a local standard of intravenous antibiotics within 60 minutes of presentation, suspects neutropenic sepsis after anticancer treatment in the last 6 weeks with a temperature over 38 °C or under 36 °C, tells staff not to wait for blood count results, and in haematology lets assessed nurses give the first dose of piperacillin with tazobactam under a patient group direction. MASCC scoring is used for solid tumours only.","evidence":"A local policy that cites NICE CG151; it is not graded evidence.","sources":["cardiff-vale-2025"]},{"name":"Broader anti-pseudomonal choice and combination for severe cases (SEOM)","differs":"Allows piperacillin with tazobactam, meropenem, imipenem with cilastatin or cefepime as the first beta-lactam, and for high-risk patients meeting severity criteria a beta-lactam, preferably a carbapenem, with amikacin; adds a gram-positive agent for suspected line or skin infection, pneumonia or haemodynamic instability.","evidence":"SEOM grades the beta-lactam choice I, A and the carbapenem with amikacin II, A. NICE advises against a routine aminoglycoside and keeps to piperacillin with tazobactam unless there are patient-specific or local reasons.","sources":["seom-2018","nice-cg151"]},{"name":"Chest X-ray for everyone (SEOM)","differs":"Includes a chest X-ray in every initial assessment, where NICE advises one only when clinically indicated.","evidence":"SEOM grades its initial evaluation including chest X-ray III, B; NICE makes the opposite recommendation without a grade.","sources":["seom-2018","nice-cg151"]},{"name":"CISNE instead of MASCC for stable patients with solid tumours (SEOM)","differs":"Uses the Clinical Index of Stable Febrile Neutropenia (0 low, 1 to 2 intermediate, 3 or more high risk) in people with solid tumours on moderate-intensity chemotherapy who look clinically stable, and never in haematological cancers or lymphoma.","evidence":"SEOM grades CISNE II, B. In the CISNE validation cohort of 1,133 patients the area under the curve was 0.868 for CISNE against 0.721 for MASCC.","sources":["seom-2018","cisne-2015"]}],"grades":[{"claim":"Empirical antibiotics within the first hour of arrival in the emergency department, after cultures","grade":"II, A","source":"seom-2018","quote":"Empirical antibiotic therapy should be initiated within the first hour of arrival at the ED (after sampling for cultures)"},{"claim":"First intravenous antibiotic is an anti-pseudomonal beta-lactam","grade":"I, A","source":"seom-2018","quote":"Initial parenteral antibiotherapy should include a beta-lactam with activity against Pseudomonas spp. (piperacillin/tazobactam, meropenem, imipenem–cilastatin, cefepime)"},{"claim":"Blood cultures before the first antibiotic","grade":"III, A","source":"seom-2018","quote":"Two pairs of blood cultures and microbiological specimens, as clinically indicated, should be obtained prior to initiating empirical antibiotic therapy"},{"claim":"Severe cases: beta-lactam, preferably a carbapenem, with amikacin","grade":"II, A","source":"seom-2018","quote":"In high-risk patients meeting criteria for severity, initial parenteral antibiotherapy should include a beta-lactam with activity against Pseudomonas spp. (preferably a carbapenem) in combination with amikacin"},{"claim":"CISNE score for clinically stable patients with solid tumours on moderate-intensity chemotherapy","grade":"II, B","source":"seom-2018","quote":"The application of the CISNE score is recommended in patients with apparent clinical stability and solid tumors on moderate-intensity chemotherapy"},{"claim":"Outpatient route: first intravenous dose within the hour and at least 4 hours of observation","grade":"III, B","source":"seom-2018"},{"claim":"First dose of empirical antibiotic within 1 hour of triage and at least 4 hours of monitoring before discharge","grade":"consensus recommendations (ASCO/IDSA Expert Panel)","source":"asco-idsa-2018","quote":"The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for ≥ 4 hours before discharge."},{"claim":"MASCC score of 21 or more is likely to be suitable for outpatient or ambulatory care","grade":"A","source":"mascc-2026","quote":"The MASCC score is a well-validated score for risk stratification in febrile neutropenia and patients with a score ≥ 21 are likely to be suitable for outpatient or ambulatory emergency care"},{"claim":"MASCC score under 21 is high risk and needs standard neutropenic sepsis management","grade":"A","source":"mascc-2026"},{"claim":"Evidence on how fast antibiotics must be given in suspected neutropenic sepsis","grade":"very low (GRADE)","source":"nice-cg151-full","quote":"The overall quality of the evidence classified by GRADE was ‘very low’."},{"claim":"Evidence for piperacillin with tazobactam monotherapy on mortality and treatment failure","grade":"moderate (GRADE)","source":"nice-cg151-full","quote":"The overall quality of the evidence as classified by GRADE was ‘moderate’ in addressing mortality and treatment failure, and low or very low in relation to adverse effects."}],"sources":[{"key":"nice-cg151","label":"Neutropenic sepsis: prevention and management in people with cancer (CG151), recommendations","publisher":"NICE","year":2012,"url":"https://www.nice.org.uk/guidance/cg151/chapter/Recommendations","gradingScheme":"NICE does not grade recommendations; the strength is in the wording ('offer', 'do not offer', 'consider'). Published September 2012, recommendations 1.2.1.1 and 1.2.1.2 updated January 2020 and September 2024.","read":"full-text","accessed":"2026-11-11"},{"key":"nice-cg151-full","label":"Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients, full guideline and evidence review","publisher":"NICE (National Collaborating Centre for Cancer)","year":2012,"url":"https://www.nice.org.uk/guidance/cg151/evidence/full-guideline-pdf-188303581","gradingScheme":"Evidence for each question rated with GRADE as high, moderate, low or very low; recommendations themselves are not graded.","read":"full-text","accessed":"2026-11-11"},{"key":"nice-ng253","label":"Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253)","publisher":"NICE","year":2025,"url":"https://www.nice.org.uk/guidance/ng253","gradingScheme":"NICE does not grade recommendations; each is dated by the year it was written or amended, for example [2016, amended 2024].","read":"full-text","accessed":"2026-11-11"},{"key":"seom-2018","label":"SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018)","publisher":"Spanish Society of Medical Oncology (SEOM), Clinical and Translational Oncology","year":2019,"url":"https://europepmc.org/article/PMC/PMC6339667","doi":"10.1007/s12094-018-1983-4","gradingScheme":"Infectious Diseases Society of America-US Public Health Service grading system, printed as level of evidence (I to III) and grade of recommendation (letter), for example II, A.","read":"full-text","accessed":"2026-11-11"},{"key":"mascc-2026","label":"Febrile neutropenia in patients treated with chemotherapy/immune checkpoint inhibition: a MASCC consensus statement","publisher":"MASCC, Supportive Care in Cancer","year":2026,"url":"https://europepmc.org/article/PMC/PMC13421288","doi":"10.1007/s00520-026-11045-7","gradingScheme":"Ten expert-consensus position points, each graded on what the authors call the standard A to D scoring system; the grade is printed after the point.","read":"full-text","accessed":"2026-11-11"},{"key":"asco-idsa-2018","label":"Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: ASCO and IDSA Clinical Practice Guideline Update","publisher":"ASCO and IDSA, Journal of Clinical Oncology","year":2018,"url":"https://europepmc.org/abstract/MED/29461916","doi":"10.1200/JCO.2017.77.6211","read":"abstract","accessed":"2026-11-11"},{"key":"idsa-2010","label":"Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America","publisher":"IDSA, Clinical Infectious Diseases","year":2011,"url":"https://europepmc.org/abstract/MED/21258094","doi":"10.1093/cid/cir073","read":"abstract","accessed":"2026-11-11"},{"key":"esmo-2016","label":"Management of febrile neutropaenia: ESMO Clinical Practice Guidelines","publisher":"ESMO, Annals of Oncology","year":2016,"url":"https://doi.org/10.1093/annonc/mdw325","doi":"10.1093/annonc/mdw325","read":"not-reachable","accessed":"2026-11-11"},{"key":"mascc-index-2000","label":"The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients","publisher":"Journal of Clinical Oncology","year":2000,"url":"https://europepmc.org/abstract/MED/10944139","doi":"10.1200/JCO.2000.18.16.3038","read":"abstract","accessed":"2026-11-11"},{"key":"cisne-2015","label":"Prediction of Serious Complications in Patients With Seemingly Stable Febrile Neutropenia: Validation of the Clinical Index of Stable Febrile Neutropenia in a Prospective Cohort of Patients From the FINITE Study","publisher":"Journal of Clinical Oncology","year":2015,"url":"https://europepmc.org/abstract/MED/25559804","doi":"10.1200/JCO.2014.57.2347","read":"abstract","accessed":"2026-11-11"},{"key":"cardiff-vale-2025","label":"Policy for the management of suspected and proven neutropenic sepsis in adults (UHB 529)","publisher":"Cardiff and Vale University Health Board","year":2025,"url":"https://cavuhb.nhs.wales/files/policies-procedures-and-guidelines/patient-safety-and-quality/uhb-529-neutropenic-sepsis-policy-final-version-1-2-1-pdf/","read":"full-text","accessed":"2026-11-11"}],"upgrades":[],"gaps":["The ESMO 2016 guideline could not be read: it has no abstract in Europe PMC and the publisher's page refused a script. Its fever threshold, time target and antibiotic choice are not stated here.","The ASCO/IDSA 2018 update and the IDSA 2010 guideline were read only as abstracts, so their temperature definitions and full lists of first-line drugs are not given; the 2010 abstract says only that empirical antibiotic therapy should be immediate.","No guideline read here gives evidence that one hour is better than another short interval; NICE judged the evidence on timing very low quality and declined to name a period.","The UKONS 24-hour telephone triage toolkit (version 3, December 2024), which most UK cancer helplines use, returned a page-not-found to a script and is not cited.","NICE gives no specific first antibiotic for people with a penicillin allergy and leaves it to clinical judgement and local policy.","The MASCC score has not been validated in people having chemotherapy combined with immune checkpoint inhibitors (MASCC 2026), and SEOM says CISNE must not be used in haematological cancers or lymphoma."]},"route":"/protocols/febrile-neutropenia-first-hour/","neighbours":{"idea":[{"id":"idea-acc-acute-oncology-assessment-units","kind":"idea","name":"Acute oncology assessment units so sick cancer patients bypass the emergency department","route":"/ideas/idea-acc-acute-oncology-assessment-units/"},{"id":"idea-acc-hospital-at-home-oncology","kind":"idea","name":"Hospital-at-home for oncology: treating low-risk febrile neutropenia and dehydration at home","route":"/ideas/idea-acc-hospital-at-home-oncology/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"implanted-ports","kind":"technology","name":"Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)","route":"/technologies/implanted-ports/"},{"id":"picc-lines","kind":"technology","name":"Peripherally inserted central catheters (PICC lines)","route":"/technologies/picc-lines/"}],"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"},{"id":"mascc","kind":"institution","name":"Multinational Association of Supportive Care in Cancer","route":"/institutions/mascc/"},{"id":"nice","kind":"institution","name":"National Institute for Health and Care Excellence","route":"/institutions/nice/"}],"term":[{"id":"central-venous-access","kind":"term","name":"Central venous access (port, PICC line)","route":"/terms/central-venous-access/"},{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"neutropenia","kind":"term","name":"Neutropenia","route":"/terms/neutropenia/"},{"id":"neutropenic-sepsis-breast-chemotherapy","kind":"term","name":"Neutropenic sepsis: the temperature rule and the 999 signs","route":"/terms/neutropenic-sepsis-breast-chemotherapy/"}],"protocol":[{"id":"acute-oncology-telephone-triage","kind":"protocol","name":"Acute oncology telephone triage: the 24-hour helpline and the UKONS red, amber and green grading","route":"/protocols/acute-oncology-telephone-triage/"},{"id":"antibacterial-prophylaxis-in-neutropenia","kind":"protocol","name":"Antibacterial (fluoroquinolone) prophylaxis during expected severe neutropenia","route":"/protocols/antibacterial-prophylaxis-in-neutropenia/"},{"id":"crs-grading-and-management","kind":"protocol","name":"Cytokine release syndrome after CAR T-cell therapy: ASTCT grading, tocilizumab and steroids","route":"/protocols/crs-grading-and-management/"},{"id":"treatment-induced-diarrhoea-grading-and-management","kind":"protocol","name":"Diarrhoea from chemotherapy, targeted therapy and radiotherapy: grading, loperamide, octreotide and when to admit","route":"/protocols/treatment-induced-diarrhoea-grading-and-management/"},{"id":"paediatric-fever-and-neutropenia","kind":"protocol","name":"Fever and neutropenia in children with cancer or after stem cell transplant","route":"/protocols/paediatric-fever-and-neutropenia/"},{"id":"g-csf-prophylaxis-by-febrile-neutropenia-risk","kind":"protocol","name":"G-CSF prophylaxis by febrile neutropenia risk","route":"/protocols/g-csf-prophylaxis-by-febrile-neutropenia-risk/"},{"id":"irinotecan-early-cholinergic-syndrome-and-late-diarrhoea","kind":"protocol","name":"Irinotecan: early cholinergic syndrome and late diarrhoea","route":"/protocols/irinotecan-early-cholinergic-syndrome-and-late-diarrhoea/"},{"id":"neutropenic-enterocolitis","kind":"protocol","name":"Neutropenic enterocolitis (typhlitis): imaging, cultures, antibiotics and conservative care","route":"/protocols/neutropenic-enterocolitis/"},{"id":"suspected-central-line-infection","kind":"protocol","name":"Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage","route":"/protocols/suspected-central-line-infection/"}]}}