CISNE Score for Febrile Neutropenia
Clinical Index of Stable Febrile Neutropenia (CISNE) — identifies low-risk solid tumour patients with febrile neutropenia suitable for oral antibiotics and early discharge.
Score interpretation
CISNE 0: Very low risk of serious complications (< 2%). Eligible for oral antibiotics and early discharge.
→ Oral ciprofloxacin 500–750 mg BD + amoxicillin-clavulanate 625 mg TDS (or oral co-amoxiclav 625 mg TDS alone if fluoroquinolone-resistant risk). Discharge with clear safety-net instructions. Return if: fever persists > 48h, new symptoms, or clinical deterioration. Follow-up in 24–48 hours.
CISNE 1–2: Intermediate risk (~6% serious complications). Consider inpatient IV antibiotics.
→ IV piperacillin/tazobactam 4.5g TDS or ceftazidime 2g TDS (NICE NG143). Monitor 24–48h. Reassess for de-escalation to oral if clinically stable after 24h. Blood cultures × 2 before antibiotics. MASCC score as complementary tool.
CISNE ≥ 3: High risk (> 15% serious complications). Inpatient IV antibiotics mandatory.
→ IV piperacillin/tazobactam 4.5g TDS. Add IV gentamicin if septic shock or Gram-negative suspicion. Vancomycin if line-related infection or MRSA risk. Blood cultures × 2, urine, CXR. Daily review. Consider antifungal after 4–7 days of persistent fever (caspofungin or fluconazole). G-CSF if delayed recovery.
Interpretation bands for the CISNE. Apply clinical judgement and local guidance.
References
- Carmona-Bayonas A et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol. 2015.
- NICE NG143. Neutropenic sepsis: prevention and management in people with cancer. 2012.
Related
Curated clinical cross-links plus same-class fallbacks.
- Meropenem (Paediatric) · Carbapenem — Severe / MDR Gram-Negative Infections / Febrile Neutropenia
- Ciprofloxacin Ear Drops · Topical Fluoroquinolone Antibiotic
- Ciprofloxacin · Fluoroquinolone Antibiotic
- Ciprofloxacin · Fluoroquinolone antibiotic
- Ciprofloxacin with dexamethasone · Topical otic antibiotic + corticosteroid
- Ciprofloxacin with fluocinolone acetonide · Topical otic antibiotic + corticosteroid
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.