Febrile neutropenia is a common complication arising in cancer patients during course of chemotherapy. Febrile neutropenia poses a significant challenge in the management of high-risk patients, often requiring broad-spectrum antibiotic therapy.¹ The choice of agents are modified as further investigations reveal any specific organism and, or depending on the clinical assessment of the patient. In a large number of cases, no definite focus of infection can be identified. The optimal management approach (duration or inpatient /outpatient setting) is still debatable.

It is quite common practice to continue empirical antimicrobial therapy (EAT) until neutrophil recovery which could prolong the therapy unnecessarily. ²

Optimization of antimicrobial therapy is necessary in an era of growing antimicrobial resistance, particularly important in management of patients with hematological malignancies on chemotherapy as they are often exposed to the collateral damage of prolonged broad-spectrum antimicrobial therapy including drug toxicity and predisposition to fungal infections and Clostridium difficile-associated diarrhea.^3,4,5

To reduce side effects, antibiotic selective pressure on the human microbiota, and antimicrobial resistance development, a more rational use of antibiotics is necessary. ⁶

Therefore, if safe, stopping antibiotic therapy earlier in patients without signs of a bacterial infection could provide significant benefits.

We aimed to establish whether discontinuation of EAT driven by an integrated approach regardless of neutrophil recovery would optimize the duration of antibiotic therapy.

Rationale: The extended use of antibiotics contributes to:

1.      Antimicrobial resistance

2.      Adverse effects

3.      Ineffective man-hour usage especially in low resource setting

4.      Excessive cost

Hence, we want to explore antibiotic discontinuation policy in high-risk febrile neutropenia without focus in adult malignancy.