Empiric therapy for neutropenic fever typically involves which approach?

• A. Broad-spectrum IV antibiotics with Pseudomonas coverage (eg, piperacillin-tazobactam or cefepime)
• B. Narrow-spectrum oral antibiotics only
• C. Antiviral therapy only
• D. No antibiotics unless bacteremia is proven

Answer: (A)

Neutropenic fever demands prompt, broad-spectrum IV antibiotics with anti-pseudomonal activity. The underlying concept is that when neutrophils are very low, the body cannot mount an effective defense, so bacterial infections can escalate quickly. Starting empiric therapy right away—ideally within an hour of fever in a patient with neutropenia—targets Pseudomonas and other common gram-negative pathogens, improving survival. Piperacillin-tazobactam or cefepime are typical choices because they provide wide coverage, including anti-pseudomonal activity, and can be used as initial monotherapy in many stable patients. The other options don’t fit: narrow-spectrum oral antibiotics won’t reliably cover Pseudomonas in this setting; antiviral therapy alone doesn’t address bacterial risk; and waiting for bacteremia to be proven before starting antibiotics delays crucial treatment. After cultures return, therapy can be refined based on sensitivities.