Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients

A survey of the management of neutropenic fever in oncology units in the UK

“…A recent meta-analysis concluded that oral antibiotics may be safely offered to neutropenic patients with fever who are at low risk for mortality [13]. Our survey showed that less than one-third of UK oncology units considered using oral antibiotic therapy in FN, despite the fact that many oncology patients might fall into the low-risk category.…”

A prospective study of chemotherapy-induced febrile neutropenia in the South West London Cancer Network. Interpretation of study results in light of NCAG/NCEPOD findings

“…Recent advances in the management of febrile neutropenia have highlighted the value of risk stratification and the evolving role of oral antibiotics with early hospital discharge in low-risk patients (Freifeld et al , 1999; Kern et al , 1999; Hughes et al , 2002). The Multinational Association for Supportive Care in Cancer has developed a risk index for the development of febrile neutropenia (Klastersky and Paesmans, 2007) and studies have shown that outpatient oral antibiotics are feasible in low-risk patients (Innes et al , 2003; Vidal et al , 2004; Klastersky and Paesmans, 2007). To our knowledge, this stratification is not routinely used in the UK (Innes et al , 2005) but will be an increasing area of interest, with important implications on decreased inpatient costs and improved patient convenience with outpatient care.…”

A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment

“…2,3 However, requirement for inpatient hospitalisation depends upon whether the risk of developing significant medical complications is 'low' or 'high'. [4][5][6] Typically, low-risk FN patientsgenerally patients with solid tumours and low burden of symptoms and comorbid conditionshave less than 7% risk of developing medical complications and less than 1% mortality. [6][7][8] High level evidence has consistently shown that low-risk FN patients can be safely managed in an ambulatory setting, provided patients are appropriately selected and adequate outpatient services areavailable to monitor patients and respond to any clinical deterioration.…”

“…[4][5][6] Typically, low-risk FN patientsgenerally patients with solid tumours and low burden of symptoms and comorbid conditionshave less than 7% risk of developing medical complications and less than 1% mortality. [6][7][8] High level evidence has consistently shown that low-risk FN patients can be safely managed in an ambulatory setting, provided patients are appropriately selected and adequate outpatient services areavailable to monitor patients and respond to any clinical deterioration. [9][10][11][12][13] A recent survey of Australian clinicians highlighted support for ambulatory care strategies.…”