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In perspective
Routine antibiotics in the febrile cancer patient: should immune checkpoint inhibitors affect our practice?
  1. Katie Walker1,2,
  2. Kathryn Yu3,4,
  3. Zhi Shyuan Seraphina Choong3,4,
  4. Anne Loupis3,
  5. Gary Richardson5
  1. 1 Emergency Department, Casey Hospital, Berwick, Victoria, Australia
  2. 2 School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  3. 3 Emergency Medicine, Cabrini Health, Malvern, Victoria, Australia
  4. 4 Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  5. 5 Szalmuk Family Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
  1. Correspondence to Professor Katie Walker, Emergency Department, Casey Hospital, Berwick, VIC 3806, Australia; katie_walker01{at}yahoo.com.au

https://doi.org/10.1136/emermed-2020-210224

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    Cancer is a common illness with a prevalence of 1.8 million new cases and 600 000 deaths per annum in the USA alone.1 Approximately 10% of patients with cancer will attend an emergency department (ED) within 30 days of diagnosis or treatment,2 and 4.5 million sufferers from active cancer visit EDs in the USA annually, with 14%–20% of emergency visits related to fevers.3 4 Chemotherapy patients with fevers are highly likely to be treated with antibiotics during their ED visit, often shortly after arrival, prior to haematology results, to avoid a subset of patients deteriorating with sepsis or neutropaenic sepsis. In multicentre USA cohorts, antibiotics were administered to 26.5% of adult emergency oncology patients with fevers,3 and some paediatric oncology protocols recommend that all oncology patients with a fever receive antibiotics.5

    Immune checkpoint inhibitor therapies are now widely indicated in numerous cancer types, particularly those whose tumours are inflammatory.6 For those with …

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    Footnotes

    • Handling editor Gene Yong-Kwang Ong

    • Contributors KW and GR wrote the letter; KY, ZSSC and AL undertook a literature review on the topic.

    • Funding The Cabrini Research Institute has been funded by Roche, Bristol Myers Squibb, Merck & Co and AstraZenica for clinical trials investigating Immune checkpoint inhibitors.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.