Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Abstract

Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating deescalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.

Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment

“…We expect the results of our study to be largely in line with the generally high antimicrobial consumption in pediatric oncology/hematology, given the ample evidence in the existing literature [ 20 , 21 ]. There are limitations to the study design that deserve mentioning.…”

Antimicrobial use in pediatric oncology and hematology in Germany and Austria, 2020/2021: a cross-sectional, multi-center point-prevalence study with a multi-step qualitative adjudication process

“…Future studies should aim to analyze the facilitators and barriers to guideline adherence, as well as to implementing AMS in pediatric oncology and hematology units, and should include qualitative and mixed-methods approaches. 29 , 30 …”

Cost‐effectiveness of home‐based care of febrile neutropenia in children with cancer

“…2 There is a growing body of evidence that home-based care with oral or intravenous antibiotics in carefully selected children with low-risk FN is safe and effective. 3,4 To date, much of the focus has been on the clinical impact of this model, with limited data on the direct economic impacts on both the family and the health care system. 5 While safety remains paramount, the paucity of robust economic and quality-of-life (QoL) data for home-based FN care may, in part, explain the slow and inconsistent uptake of these treatment pathways.…”

“…Risk stratification strategies are recommended to differentiate children with FN at low and high risk for infection so treatment can be tailored accordingly 2 . There is a growing body of evidence that home‐based care with oral or intravenous antibiotics in carefully selected children with low‐risk FN is safe and effective 3,4 . To date, much of the focus has been on the clinical impact of this model, with limited data on the direct economic impacts on both the family and the health care system 5 .…”