In pediatric oncology, what are the core steps in managing febrile neutropenia?

• A. Prompt evaluation with cultures, start broad‑spectrum anti‑pseudomonal antibiotics within 1 hour of fever, monitor vitals, isolate if needed, adjust therapy per culture results.
• B. Antibiotics only after fever resolves.
• C. Only monitor vitals; no antibiotics initially.
• D. Initiate antifungal therapy first.

Answer: (A)

Prompt evaluation with cultures and starting broad-spectrum anti-pseudomonal antibiotics within 1 hour of fever onset is essential because febrile neutropenia can progress rapidly to sepsis in a child with cancer. Neutropenia blunts typical infection signs, so delaying antibiotics increases risk. Obtaining cultures (blood first, then urine and other sites as indicated) helps identify the pathogen and guides later narrowing of therapy. Monitoring vital signs continuously and instituting isolation precautions as needed protect the patient and others while the infection is being assessed. Therapy is then adjusted based on culture results and the patient’s response, tailoring treatment to the actual organism and ensuring de-escalation when appropriate to limit toxicity. The other options miss the urgency and the need for immediate empiric coverage; antifungal therapy is not first-line unless fever persists despite appropriate antibacterial treatment or a fungal infection is suspected.