FRCR VAULT

Miscellaneous: Oncological emergency: neutropenic sepsis

Free question published 11 September 2026

MiscellaneousOncological emergency: neutropenic sepsis

A 49-year-old woman receiving FEC chemotherapy for breast cancer attends the acute oncology unit on day 10 of her cycle feeling unwell, with a temperature of 38.6 degrees Celsius. Her neutrophil count is 0.3 x 10 to the 9 per litre. She has no penicillin allergy. What is the most appropriate initial empirical antibiotic therapy?

  1. AOral co-amoxiclav and ciprofloxacin as an outpatient
  2. BPiperacillin combined with tazobactam along with an aminoglycoside (such as gentamicin)
  3. CVancomycin monotherapy
  4. DAwait blood culture results before starting antibiotics
  5. EBeta-lactam monotherapy with piperacillin with tazobactam given immediately

Why E is correct

This patient meets the NICE CG151 definition of neutropenic sepsis (neutrophils 0.5 x 10 to the 9 per litre or lower with temperature above 38 degrees Celsius) and must be treated as an acute medical emergency. NICE recommends offering beta lactam monotherapy with piperacillin with tazobactam as initial empirical therapy, given immediately, unless there are patient-specific or local contraindications. An aminoglycoside should not be added routinely.

And why the others are not

  • AOral outpatient antibiotics are reserved for low-risk patients (high MASCC score); a day-10 febrile patient with neutrophils 0.3 needs immediate IV therapy.
  • BNICE advises against routinely adding an aminoglycoside to piperacillin-tazobactam monotherapy unless specific indications exist.
  • CVancomycin monotherapy does not cover the Gram-negative organisms that are the priority in neutropenic sepsis and is not first-line.
  • DDelaying antibiotics for culture results is dangerous; neutropenic sepsis demands immediate empirical treatment.

Source NICE CG151 - Neutropenic sepsis: prevention and management in people with cancer — National Institute for Health and Care Excellence. Neutropenic sepsis: prevention and management in people with cancer. NICE clinical guideline CG151. Published September 2012.

More free miscellaneous questions

Sitting in February? Follow the twenty-week plan.

2,500+ cited questions like this one are waiting in the vault.

See plans and pricing