Oral versus intravenous antibiotics in treatment of paediatric febrile neutropenia

Abstract

The purpose of this study is to determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode. A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics with intravenous antibiotics in the treatment of febrile neutropenic episodes in low-risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RRs) for dichotomous data and mean difference with standard deviation for continuous data. Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% confidence interval 0.78-1.32, P= 0.91). In carefully selected low-risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics as they lower the cost of treatment as well as psychosocial burden on these children and their families.

Efficacy and Safety of Sitafloxacin in Treating Low-risk Febrile Neutropenia in Patients with Lung Cancer

“…Vedi and colleagues performed a meta-analysis and found that, in carefully selected low-risk children with FN, empirical treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics and decreases the cost of treatment and the psychosocial burden on these children and their families (15) . A Cochrane study demonstrated that oral antibiotic treatment is an acceptable alternative to intravenous treatment in patients with cancer and FN (excluding patients with acute leukemia) who are hemodynamically stable and do not present with organ failure, pneumonia, infection of a central line, or severe soft-tissue infection (16) .…”

The cost of a “benign” condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia

“…Additional intangible yet important costs include parental and patient anxiety, travel costs, and missed time from school or work. In the oncology realm, research has identified effective cost savings when stratifying low‐risk patients with fever and neutropenia for conservative management, and the population of patients with AIN presents an optimal group for consideration of such conservative management …”

“…Patients and families are often given strict infectious precautions including the recommendation to present to the emergency center (EC) for the assessment of fever and antibiotic administration. Although research has focused on cost data for fever and neutropenia in patients with oncologic diagnoses, data on healthcare utilization and rates of serious infections in young patients with AIN are limited. The objective of this study was to evaluate subspecialty and emergency healthcare utilization and rate of clinically significant infections in young children with primary AIN at a large tertiary care children's hospital.…”

Complications of sepsis: the role of risk prediction rules, biomarkers and host genetics

“…However, several important differences between adults and children with cancer exist, which preclude the applicability of adult-derived febrile neutropenia guidelines in the pediatric setting [12]. Recently, a number of reviews have been published, which summarize existing data for the management of low-risk pediatric febrile neutropenia and have identified key areas where evidence and guidelines are scant [13][14][15][16].…”

“…Results of randomized trials suggest that outpatient management is more cost effective and may be a safe alternative in a carefully selected group of children [15]. Furthermore, some trials have shown success with oral antibiotics, although significant variability with time to randomization following in-patient parenteral antibiotics exist [14]. There is uniform agreement between these studies on the need for a more reliable risk stratification tool before oral and/or ambulatory treatment options for pediatric febrile neutropenia can be safely recommended.…”