In suspected febrile neutropenia, which actions are performed first?

• A. Start antivirals first
• B. Avoid antibiotics until culture results
• C. Obtain blood cultures and start broad-spectrum IV antibiotics promptly (ideally within 60 minutes)
• D. Delay antibiotics until culture results

Answer: (C)

In febrile neutropenia, the priority is to treat promptly because a neutropenic patient can deteriorate quickly from infection with little usual warning signs. The first actions are to obtain blood cultures and initiate empiric broad-spectrum IV antibiotics without delay, ideally within 60 minutes of presentation. Draw blood cultures from multiple sites if feasible before starting antibiotics, but do not wait for culture results to begin therapy. The chosen antibiotics should cover common pathogens in neutropenic patients, especially Pseudomonas and other Gram-negative organisms, with adjustments based on local guidelines and patient risk factors. Antivirals or waiting for culture results are not the initial steps, as delaying antibiotics worsens outcomes in this setting.