A 45-year-old woman is undergoing chemotherapy for breast cancer. She presents 10 days after her last chemotherapy with fever (temperature >38.5), but no other symptoms except a sore throat and mouth. On examination, she looks well, there is oral mucositis, ears are normal, lungs are clear, and the central line site is clean. The CXR, urinalysis, and biochemistry are normal. Her WBC is 800/mL and the absolute neutrophil count is low (<500). Which of the following is the most appropriate next step in management?

**Core Concept**
Fever in a neutropenic patient, particularly after chemotherapy, poses a significant risk of severe infection, sepsis, or death. The neutropenic patient's compromised immune system makes them more susceptible to infections.

**Why the Correct Answer is Right**
Given the patient's presentation of fever, sore throat, and oral mucositis with a low absolute neutrophil count, the most critical step is to initiate empiric antibiotic therapy. This approach covers a broad spectrum of potential pathogens, including gram-positive and gram-negative bacteria, as well as fungi, which are common causes of infections in neutropenic patients. The choice of antibiotics should be based on local hospital antibiotic resistance patterns and the patient's specific risk factors.

**Why Each Wrong Option is Incorrect**
**Option A:** Waiting for culture results before starting antibiotics is not advisable in a neutropenic patient with fever, as this can delay initiation of potentially life-saving therapy.
**Option B:** Administering antiviral medication would be appropriate if the patient had a viral infection, but the presentation and symptoms suggest a bacterial or fungal infection.
**Option C:** Performing a CT scan of the lungs or other areas may be useful in some cases, but it is not the most appropriate next step in management of a neutropenic patient with fever.

**Clinical Pearl / High-Yield Fact**
In neutropenic patients, empiric antibiotic therapy should be initiated promptly, and it is crucial to consider the local hospital antibiotic resistance patterns to guide the choice of antibiotics.

**Correct Answer:** C. Administer broad-spectrum empiric antibiotics (e.g., piperacillin-tazobactam or cefepime) and antifungal agents (e.g., fluconazole or caspofungin) and consider adding vancomycin or linezolid if there is a high suspicion of MRSA.

✓ Correct Answer: A. start empiric bacterial antibiotics