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

Abstract

These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.

Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

“…The success rate of the treatment was 84% (63 of 75 episodes), and 71 of 75 episodes (95%) were resolved without hospitalization. Several studies evaluating the use of oral antibiotics in the outpatient management of low-risk FN have reported treatment success rates of 77-95% (10,(14)(15)(16)(17), which is consistent with the results of the present study.…”

Oral moxifloxacin for outpatient treatment of low-risk, febrile neutropenic patients

“…Since these studies were conducted gatifloxacin has been withdrawn from clinical use. Moxifloxacin has also been evaluated for prophylaxis as well as empiric therapy in febrile neutropenic patients [2,23,27]. Chamilos and colleagues treated 54 patients with solid and hematologic malignancies with oral, outpatient moxifloxacin [2].…”

“…These trials showed promising results but are no longer pertinent since gatifloxacin has been withdrawn from clinical use due to toxicity issues. Moxifloxacin has also been evaluated in this setting with response rates in the 80-91% range [2,23]. We have conducted a pilot study of oral outpatient moxifloxacin monotherapy in low-risk febrile neutropenic patients and would like to add our experience to that which has already been published.…”

“…Most lowrisk patients receive oral antibiotics, generally a combination of a quinolone such as ciprofloxacin and agents such as amoxicillin/clavulanate, clindamycin, or azithromycin to provide broad-spectrum coverage against pathogens commonly encountered in this setting [9]. Parenteral outpatient therapy has also been shown to be safe and effective in lowrisk patients who are unable or unwilling to receive oral therapy [14,17,18,23]. Older quinolones (ofloxacin, ciprofloxacin) have been evaluated as single agents in small trials, with limited success, and are not recommended as monotherapy [10,18].…”

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…with oral treatment for neutropenia in cancer patients, but reported no methodological details of the parent studies. 22,[48][49][50][51] In the remaining five trials, details of randomisation, allocation concealment and blinding (especially in relation to assessment of outcome measures) were poorly reported. 52 The five case-control studies (three of which were retrospective) rated low for potential bias (median 8/9; range 6-9).…”