Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: Results of a prospective randomized trial

Continuous infusion of ceftazidime for patients with breast cancer and multiple myeloma receiving high-dose chemotherapy and peripheral blood stem cell transplantation

“…9,11,12 Talcott et al 10 showed that the complication rate in patients with fever and neutropenia was 34% if risk factors were present, and only 5% if they were absent. In contrast to studies including patients with an expected neutropenia of Ͻ10 days, 8,13,14 we demonstrate that BC and MM patients up to the age of 63 years in stable clinical condition (Karnofsky у70 ) receiving HDCT with PBSCT who have febrile neutropenia lasting at least 10 days are candidates for outpatient treatment, independent of the underlying disease. The median duration of neutropenia was 11 days in both groups, of which 8 days (group I) vs 7 days (group II) were recorded after beginning of ceftazidime therapy.…”

“…7,8,21 However, considerations relating to antibiotic bioavailability and tissue concentrations as well as patient compliance render treatment with some antibiotics unsuitable in an outpatient setting. 6,8,22 For example, deaths attributed to non-compliance with oral therapy have been reported by Malik et al 8 The data from Kern et al 23 indicate that in low-risk patients an oral combination therapy consisting of ciprofloxacin plus amoxillin-clavulanate is as effective as ceftriaxone plus amicacin. However, patients were admitted to hospital in the latter multicentre trial.…”

“…6 Several studies have identified factors associated with favourable outcome if patients are treated on an outpatient basis. 7,8 The aim of this prospective study was to determine whether the continuous infusion of ceftazidime followed, if necessary, by the addition of a glycopeptide antibiotic in neutropenic patients with persistent fever is adequate and safe as a first-line therapy. In addition, we wished to determine if the underlying disease has an impact on the risk and treatment strategy of infectious complications.…”

Neutropenia febril: análisis de los factores pronósticos y el tratamiento adaptado al riesgo. Revisión crítica

“…En la última década, se han comunicado las primeras experiencias en este sentido [14][15][16] , pero en general, no se puede descartar que los pacientes reclutados no hayan sido expuestos a un exceso de riesgo innecesario. Se trata de estudios de tratamiento ambulatorio con escaso tamaño muestral, con criterios de inclusión y esquemas de antibióti-cos poco comparables, lo que dificulta un análisis crítico correcto, y las elevadas tasas de reingresos y complicaciones pueden resultar inaceptables, en pacientes que en teoría tenían bajo riesgo.…”

“…La tendencia de la mayoría de los grupos de trabajo es establecer parámetros que permitan diseñar estrategias diagnósticas y terapéuticas individualizadas, basadas en la predicción del riesgo, sin olvidar las particularidades epidemiológicas y de la flora bacteriana en cada centro. Recientemente se han publicado varios ensayos randomizados que han sugerido que el tratamiento domiciliario puede ser tan eficaz como el ingreso con antibióticos intravenosos [14][15][16] . No obstante, los criterios de inclusión de dichos estudios utilizan modificaciones empíricas de los modelos pronósticos de Talcott y Mascc, que tienen tasas de error del 5-6%.…”