Management of Febrile Neutropenia in Patients Receiving Myelosuppressive Chemotherapy: Current Guidelines and Clinical Practice

Abstract

Febrile neutropenia (FN) is one of the most serious oncologic emergencies associated with myelosuppressive chemotherapy and is linked with significant morbidity, mortality, prolonged hospitalization, interruption of chemotherapy schedules, and increased healthcare costs. FN commonly develops in patients receiving cytotoxic chemotherapy for haematological malignancies and solid tumours, particularly during periods of severe neutropenia. Prompt recognition and evidence-based management are essential to reduce complications and improve treatment outcomes. Current international guidelines emphasize early risk identification, immediate initiation of empirical broad-spectrum antibiotics, appropriate microbiological investigations, and supportive care measures including granulocyte colony-stimulating factor (G-CSF) prophylaxis in selected high-risk patients. The use of validated scoring systems such as the Multinational Association for Supportive Care in Cancer (MASCC) score and Clinical Index of Stable Febrile Neutropenia (CISNE) assists clinicians in identifying patients suitable for outpatient management. Advances in antimicrobial therapy and infection prevention strategies have improved clinical outcomes in recent years. However, challenges including multidrug-resistant organisms, inappropriate antibiotic use, delayed diagnosis, and chemotherapy dose modifications continue to affect patient care. This review comprehensively discusses the epidemiology, pathophysiology, clinical presentation, risk assessment, current management guidelines, antimicrobial therapy, role of G-CSF prophylaxis, preventive strategies and emerging clinical practices in the management of febrile neutropenia among patients receiving myelosuppressive chemotherapy