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

Authors

  • G Naidu Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
  • D P Moore Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • T Reljic Research Methodology and Biostatistics Core, College of Medicine Office of Research, University of South Florida, Tampa, USA
  • N Azar Childhood Cancer Foundation South Africa, Rivonia, South Africa
  • N Bhakta Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA
  • A Cassim epartment of Pharmacy, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
  • K Coopasamy Department of Paediatrics and Child Health, Grey’s Hospital and University of KwaZulu-Natal, Pietermaritzburg, South Africa
  • H de Quintal Division of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa
  • L du Plessis Department of Paediatrics and Child Health, Robert Mangaliso Sobukwe Hospital, University of the Free State, Kimberley, South Africa
  • S-A Falcon Childhood Cancer Foundation South Africa, Rivonia, South Africa
  • B Goodwin Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
  • L Johnson Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA
  • M Jonas Department of Paediatrics and Child Health, Universitas Academic Hospital and University of the Free State, Bloemfontein, South Africa
  • V Moreno Berrio Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA
  • F Naby Department of Paediatrics and Child Health, Grey’s Hospital and University of KwaZulu-Natal, Pietermaritzburg, South Africa
  • B Neethling Department of Paediatrics and Child Health, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
  • F Omar Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, South Africa
  • A Omotola Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA
  • H Rabie Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
  • A van Zyl Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
  • A Whitelaw Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
  • S Licona epartment of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA
  • A Kumar Research Methodology and Biostatistics Core, College of Medicine Office of Research, University of South Florida, Tampa, USA
  • S Mukkada Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, USA

DOI:

https://doi.org/10.7196/SAMJ.2026.v116i5b.4656

Keywords:

South African Pediatric Guideline for Fever with Neutropenia

Abstract

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.

References

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Published

2026-06-02

Issue

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

Section

Guidelines

License

Copyright (c) 2026 G Naidu, D P Moore, T Reljic, N Azar, N Bhakta, A Cassim, K Coopasamy, H de Quintal, L du Plessis, S-A Falcon, B Goodwin, L Johnson, M Jonas, V Moreno Berrio, F Naby, B Neethling, F Omar, A Omotola, H Rabie, A van Zyl, A Whitelaw, S Licona, A Kumar, S Mukkada

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How to Cite

1.
Naidu G, Moore DP, Reljic T, Azar N, Bhakta N, Cassim A, et al. Clinical practice guidelines for the management of fever and neutropenia in South African children and adolescents with cancer. S Afr Med J [Internet]. 2026 Jun. 2 [cited 2026 Jun. 3];116(5B):e4656. Available from: https://www.samajournals.co.za/index.php/samj/article/view/4656