Question 2: Unexpected neutropenia in a febrile, but immunocompetent, child

Knight, Kathryn

doi:10.1136/archdischild-2015-309497

Cited by 7 publications

(4 citation statements)

References 11 publications

(21 reference statements)

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“…Neutropenia was defined as an ANC ≤ 1500 cells/µL, with severe neutropenia defined as an ANC < 500 cells/µL. [5][6][7][8] Each episode of neutropenia recurring after normalization of the ANC was considered a separate episode. Demographic data were collected, as was every ANC value obtained during the course of antibiotic therapy from the elec-tronic medical record, in addition to any complications felt to be related to neutropenia (assessed via review of inpatient and clinic notes, laboratory values, and home health records for each neutropenic subject by Pediatric Infectious Disease faculty [WD]).…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6] In children, this may result from a variety of insults, including medication toxicities, congenital processes, viral infections, and overwhelming bacterial sepsis. 2,7 Neutropenia may predispose a patient to an increased risk of infection, particularly with some forms of medically induced immunosuppression (e.g., chemotherapy received by oncology patients). 2,8 Antibiotics are one of the most commonly used medications in children, with up to one-third of all hospitalized children receiving at least 1 antibiotic during their stay.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

Solis¹,

Dehority²

2019

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC < 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79–0.93; p < 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01–1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01–1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02–1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

Solis¹,

Dehority²

2019

The Journal of Pediatric Pharmacology and Therapeutics

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“…Drug-induced neutropenia is the second commonest cause of acquired acute neutropenia in children, after post-infectious neutropenia ( Barg et al, 2015 ; Knight, 2015 ). The true incidence of this phenomenon is not known, as most reports focus on the rare and more severe agranulocytosis, which has an incidence of 1–10 cases per million per year.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-Induced Neutropenia in Pediatric Patients: New Insights From Pharmacoepidemiological Analyses and a Systematic Review

et al. 2022

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Aim: to characterize pediatric cases of antibiotic-associated neutropenia through a multidisciplinary approach, focusing on the temporal association between the wide spectrum of treatment options and the occurrence of this relatively uncommon but potentially clinically relevant adverse event.Methods: we carried out a pharmacoepidemiological analysis based on the FDA Adverse Event Reporting System (FAERS) database, a retrospective chart review and a systematic review of the literature, focusing on the time to onset (TTO) of this side effect, in the pediatric clinical setting.Results: A total of 281 antibiotic-related neutropenia events, involving 11 categories of antibiotics, were included in the time to onset analysis. The median TTO ranged from 4 to 60 days after the start of the therapy. A shorter median TTO was found from the retrospective chart review [16 patients: median days (25th-75th percentiles) = 4 (3–5)], compared to 15 (9–18) vs. 10 (6–18) for literature (224 patients) and FAERS (41 cases), respectively. The Anatomical Therapeutic Chemical classes, J01X, J01F, J01E and J04A, and the median TTOs retrieved from more than one source revealed high accordance (p > 0.05), with J01X causing neutropenia in less than a week and J01F/J01E/J04A in more than 10 days. Antibiotics were discontinued in nearly 34% of cases. In FDA Adverse Event Reporting System reports, half of the patients experiencing neutropenia were hospitalized.Conclusion: Whereas antibiotic associated neutropenia is benign in the majority of cases, yet it should not be neglected as, even if rarely, it may put children at higher risk of clinical consequences. Clinicians’ awareness of antibiotic-associated neutropenia and its mode of presentation contributes to the continuous process of monitoring safety of antibiotics.

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“…In children, febrile neutropenia is most commonly seen as a result of treatment for malignancy. Fever with unexpected neutropenia can also be found and should prompt further investigation (see the articles by James and Kinsey1 and Knight2). This article will not discuss the management of fever in children who have neutropenia of a cause other than anticancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Fifteen minute consultation: Fever in children being treated for cancer

Morgan

2018

Arch Dis Child Educ Pract Ed

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Fever is a common symptom in children receiving treatment for cancer. Clinicians and families are most concerned about febrile neutropenia, though non-neutropenic fever often causes more challenging treatment dilemmas. This article provides a structured approach to the initial assessment, examination, investigation and risk assessment of children with fever during treatment for childhood cancer. Non-neutropenic fever in children with cancer is not well researched. There are no systematic reviews of its management and no National Institute for Health and Care Excellence (NICE) (or other international) guidance about what to do. Features to consider when managing non-neutropenic fever are discussed. Febrile neutropenia, meanwhile, is an oncological emergency and requires management using standard sepsis principles including administration of broad-spectrum antibiotics. Relevant NICE guidance provides a clear structure for treatment. Ongoing management depends on the response to initial treatment.

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Question 2: Unexpected neutropenia in a febrile, but immunocompetent, child

Cited by 7 publications

References 11 publications

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

Antibiotic-Induced Neutropenia in Pediatric Patients: New Insights From Pharmacoepidemiological Analyses and a Systematic Review

Fifteen minute consultation: Fever in children being treated for cancer

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