Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients

Abstract

Based on the present data, oral treatment is an acceptable alternative to intravenous antibiotic treatment in febrile neutropenic cancer patients (excluding patients with acute leukaemia) who are haemodynamically stable, without organ failure, and do not have pneumonia, infection of a central line or a severe soft-tissue infection. The wide CI for mortality allows the present use of oral treatment in groups of patients with an expected low risk for mortality, and further research should be aimed at clarifying the definition of low risk patients.

Management of Breast Cancer Patients with Chemotherapy-Induced Neutropenia or Febrile Neutropenia

“…A meta-analysis of 22 trials showed similar mortality and treatment failure rates between oral and intravenous antibiotic treatment [38]. The analysis confirmed that oral treatment is a reasonable option in FN patients who are hemodynamically stable and have no organ failure, pneumonia, or a central line or severe soft-tissue infection.…”

“…In a sample of more than 700 patients with low-risk FN, the response rate to the empirical antibiotic regimen was 81% in outpatients and 80% in inpatients (p = 0.94). Moreover, the mean durations of the fever (2.0 vs. 2.4 days; p = 0.04) and the antibiotic therapy (8.5 vs. 9.2 days; p = 0.08) were significantly shorter among outpatients compared with inpatients [38]. Accordingly, a Cochrane review demonstrated that oral antibiotic treatment is an acceptable alternative to intravenous treatment in selected FN cancer patients [38].…”

“…Moreover, the mean durations of the fever (2.0 vs. 2.4 days; p = 0.04) and the antibiotic therapy (8.5 vs. 9.2 days; p = 0.08) were significantly shorter among outpatients compared with inpatients [38]. Accordingly, a Cochrane review demonstrated that oral antibiotic treatment is an acceptable alternative to intravenous treatment in selected FN cancer patients [38]. The mortality rate was 32 out of 1000 patients treated with an intravenous antibiotic regimen versus 30 out of 1000 patients treated with an oral regimen (risk ratio (RR) = 0.95, 95% CI 0.54-1.68).…”

“…Identification of patients suitable for outpatient management is crucial since this cost-effective strategy allows savings, limits the risk of hospital-acquired infections and improves the patients' quality of life [36,37]. FN patients with a MASCC score ≥ 21 and without other clinical warning signs can be safely managed in the outpatient setting if they are able to take oral medication and have a committed caregiver [38,39]. Successful management of CIN in BC outpatients requires the patients and their caregivers to be educated to rapidly recognize signs and symptoms of possible infection.…”

Use of risk stratification to guide ambulatory management of neutropenic fever

“…In addition to using the MASCC risk index, key clinical criteria for identifying patients with neutropenic fever at 'low risk' of medical complications, as cited in the available literature, are presented in Table 3. 2,[7][8][9] Risk and suitability of ambulatory care within specific patient populations…”