Routine antibiotics in the febrile cancer patient: should immune checkpoint inhibitors affect our practice?

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 …