Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: Randomized prospective trial

Section: Discussionmentioning

confidence: 99%

“…Both oral or parenteral antibiotics have been largely used in the outpatient setting with similar low readmission rates and high efficacy [7,8,10,12,18,19,21,24,29].…”

Section: Introductionmentioning

confidence: 99%

Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge

Sebban

Dussart

Fuhrmann

et al. 2008

“…This approach has been highly successful. In recent years, however, there has been growing interest in the oncology community in developing risk-based management strategies, which might allow lower risk patients to be treated in a manner that is less burdensome in terms of quality of life and less expensive [7,8,9,10,11,12]. In addition, treatment outside the hospital may reduce the risk of hospital-acquired secondary infections with resistant microorganisms [13].…”

Section: Introductionmentioning

confidence: 99%

“…In adult cancer patients it has been reported that the frequency of bacteremia is lower in patients with solid tumors than in those with hematological malignancies [16]. In fact, the potential risk factor of underlying malignancy has been incorporated as an eligibility criterion into a number of clinical trials of outpatient management of fever and neutropenia [8,9,11,17]. In other recent studies, patients with acute leukemias (the most common type of leukemias in pediatric patients) were not eligible for trials comparing oral and intravenous antibiotics for the treatment of fever and neutropenia [18].…”

Section: Introductionmentioning

confidence: 99%

Fever and neutropenia in children with solid tumors is similar in severity and outcome to that in children with leukemia

Koçak

Rolston

Mullen

2002

There is growing interest in developing criteria that will allow efficient prospective discrimination between cancer patients at high and at low risk for complex fever and neutropenia. The objective of this study was to determine whether there were differences in patterns of documented infections and outcome of episodes of fever and neutropenia in pediatric patients with leukemia and those with solid tumors, a potential risk factor. A total of 283 febrile neutropenia episodes in pediatric cancer patients at a single center were retrospectively reviewed; 38% of the patients concerned had leukemia and 62% had solid tumors. Fever of unexplained origin was seen in 73% and 74% of episodes in patients with leukemia and solid tumor, respectively. Bacteremia occurred in 18% and 16% of patients in these respective groups. There was no difference in the type of microorganisms that were isolated in the groups, with gram positives predominating in both. The median duration of fever was 2 days in both groups. The depth of neutropenia was similar, with 75% of leukemia patients and 70% of solid tumor patients presenting with ANC of 100 cells/microl or lower. The median duration of neutropenia was 9 days in patients with leukemia and 6 days in solid tumor patients. The median duration of antibiotic treatment was 9 days and 7.5 days in the same respective groups. Antibiotic modification occurred in 25% episodes of febrile neutropenia in leukemia patients and in 11% of episodes in solid tumor patients. No deaths occurred in either group. Subgroup analysis of leukemic patients suggested that patients in the induction phase of therapy have a higher rate of bacteremia and pneumonia. No substantial difference in course or outcome was seen between the leukemia and solid tumor groups, possibly because of the intensive treatment administered to pediatric patients with solid tumors. Risk assessment strategies based on chemotherapy dose intensity and patient comorbidities rather than underlying malignancy should be prospectively studied.

“…Of the 66 studies, 16 studies were restricted to low-risk patients [1,5,6,9,13,17,21,24,26,28,29,[31][32][33][34]41] and were thus included in this analysis. For these 16 studies, the number of studies that demonstrated low risk of bias was as follows: 13 (81%) for study participation, 14 (88%) for study attrition, 2 (13%) for confounding, and 7 (44%) for measurement of outcomes.…”

Section: Resultsmentioning

confidence: 99%

Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

Manji

Beyene

Dupuis

et al. 2012