Oncomed Clinic

Fever

If you are feeling unwell in any way after receiving chemotherapy, it's important to take your temperature. Temperatures from 99°F (37.2°C) to 100°F (37.8°C) are fairly common. But if your temperature rises to 100.5°F or above, you shall seek medical attention at your nearest clinic or contact your doctor/nurse or hospital. Fever may be your only sign of an infection.

Neutropenia

Neutropenia is a decrease in circulating neutrophils and thus body strength to fight against bacterial or other infections. Neutropenia is defined in terms of the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils in the complete blood count (CBC) differential. Fever with ANC < 1000/µL (mm3) can be worrisome. Lower the ANC higher is the risk of serious infection. Chances of having low ANC are highest during 7- 12 days after chemotherapy.

Warning Signs

Fever (temperature above 102.0° F or higher with chills and rigors
Shortness of breath or difficulty breathing or chest pain or tightness
Extreme weakness, fatigue, or dizziness or blackouts
Soreness, ulcers, or white patches in your mouth
Loose stools with pain in your tummy/ anal area while passing motions
Vaginal tenderness or discharge
Red, swollen, or tender areas of skin (pus may not form if your white blood cell count is low)

Patients more than 60 years of age OR with any history of bronchitis/recurrent respiratory complaints and or any cardiac illness are at a higher risk of complications than others during fever.

Precautions

Wash your hands often with soap and water, especially after using the toilet and before eating
Carry alcohol-based sanitizers, with you in case you don't have access to soap and water
Avoid exposure to people with cough, cold or any infectious disease /skin disorder
Avoid overcrowded places
Be extra careful not to nick or cut yourself when using a razor, knife, or scissors. Use an electric Razor when necessary
Avoid contact with cat litter boxes, pets, flowers, stuff toys and dust
Get plenty of rest and eat a well-balanced diet with plenty of liquids (water, juices, milk)
Clean your teeth and gums with a soft toothbrush and, use a mouthwash to prevent infections
Eat well cooked soft, less spicy and oily food prepared at home with clean hand and utensils

Things to do when having fever

Notify your health care professional if you have a fever greater than 38.5ºC or 100.5ºF
Know what chemotherapy drugs you are receiving (write them down). This will help if you develop a fever on an evening or weekend and need to talk to your nurse/doctor/hospital who is not familiar with your case
When you have a fever, you lose water and can become dehydrated. Therefore, it is important to drink lots of (non-alcoholic and non-caffeinated) fluid during these times
After recording your fever you can take Tablet Paracetamol (500 – 750 mg) to control fever if uncomfortable
If you have fever and neutropenia (ANC < 1000 mm3) and visit to hospital/clinic is not possible or else your doctor is unreachable then
Start oral antibiotics within one hour of onset of fever as follows
- TAB. AUGMENTIN/ CLAVUM 625 MG TWICE PER DAY and
- TAB. LEVOFLOXACIN 500 MG ONCE PER DAY

Things to do when having Febrile Neutropenia

Start i.v. antibiotics within one hour of onset of fever after collecting blood cultures (if possible) as follows
- Inj. Piperacillin plus Tazobactum (ZOSYN/PIPTAZ/TAZACT) 4.5 GRAM EVERY 6 HOURLY OR
- Inj. Cefoperazone plus sulbactum (MAGNEX) 2.0 GRAM EVERY 12 HOURLY
Monitor temperature, BP, pulse, respiratory rate, O2 saturation and do a preliminary general physical and systemic evaluation to find the source of infection if any
Maintain a strict input/output chart
Use intravenous fluids as and when necessary
Antibiotics should usually continue until the ANC is more than 1000 mm3 and patient is afebrile for 2 days
Patients should be reviewed by a medical oncologist ASAP