Oncology Patient with New Fever Clinical Pathway

As Clinically Indicated
- Sepsis Huddle
- Sepsis Pathway, ED, Inpatient and PICU

Team Assessment

History and Physical Exam
Obtain CVC or IV access
Order labs and blood cultures, consider further diagnostic studies
Review considerations for antibiotic choice and order antibiotics as indicated
Contact Oncology after placing orders
Consider stress steroids (except for CAR T-cell recipients)
Avoid ibuprofen

General oncology, autologous SCT, CAR T-cell ≥ 1 mo, hospital Blinatumomab initiation

Antibiotic Recommendations
for Special Populations
- Home Blinatumomab Infusion (New)
- CAR T-cell < 1 mo
- Allogeneic Stem Cell Transplant
- Gene Therapy Recipients

Broviac, PICC,
Medcomp/Pheresis Catheter

Port

No Line

Cefepime

Review Vancomycin Indications

Check ANC
Can use ANC w/in past 24 hrs

Inpatient Management of
Prolonged Febrile Neutropenia

ANC < 200

ANC ≥ 200

ANC < 200

ANC ≥ 200

Review Eligibility for Outpatient Treatment
with Oncology

Ceftriaxone

Review Eligibility for Outpatient Treatment
with Oncology

No antibiotics indicated

Does not meet all criteria

Meets all criteria

Discharge
home

Does not meet all criteria

Meets all criteria

Discharge home

Inpatient Management
of Prolonged
Febrile Neutropenia

Discharge with
PO Levofloxacin

Inpatient Management
of Prolonged
Febrile Neutropenia

Discharge with
PO Levofloxacin

Posted: February 2008
Revised: April 2025

Authors:
- J. Freedman, MD;
- C. Elgarten, MD;
- B. Ku, MD;
- E. Souganidis, MD;
- B. Fisher, DO;
- A. Reilly, MD;
- L. C. Bailey, MD;
- A. Bhagwat, MD;
- D. Zheng, MD;
- J. Grenier, MD;
- K. Chiotos, MD;
- L. Rodriguez, PharmD;
- K. DiGerolamo, DNP;

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Clinical Pathway for Oncology Patient Presenting with New Fever

Evidence