Selective treatment of febrile neutropenia in pediatric cancer patients Management of pediatric patients with cancer and febrile neutropenia (FN) requires appropriate identification of children at high or low risk of acquiring invasive bacterial infections (IBI), in order to implement selective treatment strategies. Based on international and our own research experience, we propose recommendations for diagnostic screening and management of children with cancer and FN according to their risk of IBI. All pediatric patients with FN must be admitted to hospital for at least 24 hours. During this period clinical and laboratory evaluations are aimed to determine their risk of IBI and to identify potential infectious focii. High risk patients should be managed in the hospital until recovery. Low risk patients can be managed as outpatients. Antimicrobial selection and possible adjustments to therapy will depend on the identification of an infectious focus, and/or local epidemiology and susceptibility patterns. Patients will require periodic clinical and laboratory reevaluation (day 3, 5 and 7 of evolution or more frequently if clinically indicated) irrespective of their risk category; response to treatment can be defined as favorable or unfavorable based in preestablished clinical and laboratory criteria in order to monitor the success of selected strategies.

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