Antibioticoterapia oral versus endovenosa em crianças neutropênicas febris recebendo quimioterapia

Abstract

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). Conclusion:There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment. No conflicts of interest declared concerning the publication of this article. 532 Jornal de Pediatria -Vol. 85, No. 6, 2009 Oral vs. intravenous antimicrobial therapy -Cagol AR et al. J Pediatr (Rio J)those at a higher risk of complications and those with good prognosis who usually present with quick fever reduction without severe complications. The identification of these factors may help to personalize treatment according to the risk factors of the febrile episode.