Clinical practice guidelines for the management of fever and neutropenia in South African children and adolescents with cancer.

BACKGROUND

Infection poses a serious risk in children and adolescents with cancer, often leading to severe morbidity and occasionally, death. Inconsistent management of fever with neutropenia (FN) may affect clinical outcomes. Despite the frequent occurrence of this complication during cancer treatment, no South African (SA) clinical practice guideline (CPG) has been developed to support clinicians in its management.

OBJECTIVE

To develop an evidence-based CPG providing recommendations for diagnosis, prognosis and management of children and adolescents with FN undergoing cancer treatment in SA.

METHOD: We developed an evidence-based CPG for managing this condition, tailored to the unique and diverse healthcare system in which children and adolescents with cancer are treated in SA. We established a working group comprising representatives from the clinical care pathway for SA children and adolescents with cancer. We then employed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to formulate the CPG recommendations.

CONCLUSION

We present two definitions and 29 recommendations for managing children and adolescents with FN. The CPG development process has yielded recommendations similar to those of other FN CPGs; however, they reflect the unique context of SA, and guide elements such as tuberculosis evaluation, focusing on essential factors including availability, accuracy, affordability and diagnostic capacity. Furthermore, the systematic review conducted as part of the evidence synthesis emphasises the need for high-quality evidence from SA settings.