Consensus guidelines for ambulatory care for neutropenic fever.
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These guidelines provide updated recommendations on ambulatory care for low-risk neutropenic fever in adult and paediatric patients. National and international data support the clinical, economic and psychosocial benefits of risk stratification, and home-based or reduced intensity treatment of neutropenic fever. Benefits include shortened in-hospital length of stay, reduced healthcare costs, early intravenous to oral switch and improved patient and caregiver quality of life. Since publication of the 2011 Australian consensus guidelines, additional adult and paediatric neutropenic fever clinical decision rules have been derived and validated. These rules assist clinicians in stratifying patients into lower or higher risk of serious infection. For adult patients the Multinational Association of Supportive Care in Cancer and the Clinical Index of Stable Febrile Neutropenia scores are recommended, whereas for paediatric patients the AUS rule has been prospectively derived and validated in the Australian setting. These rules are recommended as part of a structured low-risk neutropenic fever care pathway that incorporates additional disease-level, treatment-level and patient-level safety net criteria. Key infrastructure requirements for cost-effective and safe hospital-based ambulatory neutropenic fever care are discussed, as are recommended oral antimicrobial regimens and criteria for re-admission. Biomarkers and the use of new and wearable technologies are currently not routinely recommended as part of risk stratification or monitoring. Gaps in the literature are summarised and are anticipated to be the focus of future updates to these guidelines.