A scoring system for the risk of complications based on the Multinational Association of Supportive Care in Cancer (MASCC) predictive model is gaining increased acceptance. A score =21 of the MASCC index (maximum 26) indicates a low risk. An algorithm for the initial management of low-risk FN is shown in Figure 1.

On the other hand, the presence of the clinical site of infection, co-morbid conditions (diabetes mellitus, dehydration and organ failure), a history of documented infection, other causes of immune suppression (asplenia, high-dose steroids, purine analogues and allogeneic haematopoietic stem cell transplantation), and uncontrolled cancer (acute myeloid leukaemia not in complete remission or solid tumour progression in spite of chemotherapy) continue to be an indication for hospital-based antibiotic therapy by an intravenous (IV) route. Monotherapy with a ß-lactam (cefepime 2g every eight hours, piperacillin/ tazobactam 4.5g every six to eight hours, meropenem 1g every eight hours or imipenem/cilastatin 1g every eight hours) may be the initial choice for most patients. Initial combination therapy may be preferred under some circumstances. Signs of catheter-related infection, known colonisation with methicillinresistant Staphlococcus aureus (MRSA) and severe mucositis are indications for the inclusion of a glycopeptide (vancomycin or teicoplanin) in the empirical combination. The addition of an aminoglycoside should be considered when the infectious source is other than the central venous catheter, there is colonisation with non-fermenting gram-negative bacilli or treatment with a ß-lactam antibiotic has been administered during the previous month.