Ceftriaxone Monotherapy in the Treatment of Low-Risk Febrile Neutropenia

Abstract

Febrile neutropenia in patients who have undergone chemotherapy is usually treated with a combination of broad-spectrum antibiotics. There are no exactly defined protocols for single-agent treatment because a clear definition of low risk febrile neutropenia is lacking. This paper examines the safety and efficacy of once-daily ceftriaxone in 376 cases. Material and Methods: In a prospective observational study carried out between February 1992 and January 1996, 959 febrile episodes at 48 hospitals were recorded. Inclusion criteria were neutropenia (absolute neutrophil count, ANC <1,000/µl) with fever (≥38.5°C) or a C-reactive protein concentration >1 mg/dl and suspected infection. Nine hundred and one episodes (acute leukemia n = 396, lymphoma n = 220, solid tumors n = 272 and other disorders n = 13) in 828 patients aged between 1 and 97 years were analyzed, of which 876 episodes were evaluable for response. All patients initially underwent empirical treatment with ceftriaxone (adults: 2 g/day; children: 80 mg/kg/day), either alone (376) or in combination with other agents (525). Results: The mean ANC was 423/µl (SD ± 316) and the median duration of neutropenia 10 days. Of the 363 episodes treated initially with ceftriaxone alone, 70.8% responded versus 56.9% in the combination therapy group. The favorable response to the initial monotherapy treatment was explained by a low-risk population in the monotherapy group. A KI >6 (p < 0.0001), ANC ≥500/µl (p = 0.0001) and a duration of ANC <5 days (p < 0.05) were significantly more frequent in the monotherapy arm and were predictive of lower risk at the commencement of treatment. Conclusion: Ceftriaxone is effective in febrile neutropenia. Treatment with ceftriaxone alone was safe and highly effective in low-risk patients. Single-agent regimens appear to be a suitable treatment option in low-risk febrile neutropenia.

Ceftriaxone plus Once Daily Aminoglycoside with Filgrastim for Treatment of Febrile Neutropenia: Early Hospital Discharge vs. Standard In-Patient Care

“…The overall mortality rate (4%), the mortality rate in the randomized population (1%), as well as the infectious mortality rates in the safety and efficacy populations (2 and 1%, respectively), were comparable to those reported elsewhere [2,11,21,33,41,42] and probably reflect the difference in risk between the two populations.…”

Autologous hematopoietic progenitor cell transplantation for multiple myeloma through an outpatient program

“…This finding should offset the reconstruction of the global outpatient care model, requiring extensive coordination and implementation of resources; reduced length of hospitalization results in remarkable cost containments [55,92] and reduced exposure to hospital micro-organisms may have a favorable effect on complication rates [63,99]; neutropenic fever can be managed with single daily dose broad-spectrum antibiotics as firstline treatment in the majority of cases and only few cases require combination antibiotic therapy [44,100]; mucositis appears the most serious side-effect in the setting of outpatient transplant programs. The administration of cytoprotectors may reduce its severity and ameliorate symptoms [64,[89][90][91]101]; successful outpatient care requires the availability of a permanent outpatient service where medications and supportive care can rapidly and efficiently be provided by highly trained personnel [50,63]; patient concerns and anxiety about quality of care, the lack of a caregiver and financial constraints may represent important limitations to the large application of outpatient transplant programs.…”

Infectious complications in breast cancer patients undergoing peripheral blood stem cell transplantation: a single center retrospective analysis towards outpatient strategy

“…Mucositis prophylaxis should be emphasized, regardless of costs. Finally, a single daily injection of ceftriaxone 26 for empirical treatment of first febrile episodes could be considered, although randomized prospective studies are needed.…”