Objective: To compare the use of intravenous vs. oral antibiotic therapy. Methods:All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo.Results: A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2%; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8%; the mean length of hospital stay was 7 days (range 3-10 days).
Infective endocarditis (IE) is rare in children but is associated with substantial morbidity/mortality. Medical records of 161 new patients admitted to the Pediatric Oncology Unit in a 2 years period were reviewed to identify patients with a diagnosis of IE following the Duke criteria. Nine patients developed IE; their ages ranged from 2.4 to 11.3 years. The patients received treatment according to the results of blood cultures. TIPs are associated with a high rate of IE. The diagnosis of IE should be considered in children with cancer who have major/minor criteria as defined by the Duke criteria.
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