Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

Abstract

Based on the combination of results from all prospective studies to date, outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible.

Fever and neutropenia hospital discharges in children with cancer: A 2012 update

“…[4,5] Evidence shows that some pediatric patients with cancer who develop FN could be treated as outpatients or have an early discharge or even be treated as an outpatient. [6][7][8] Adoption of these practices would require institution specific systems to be in place for risk stratification and outpatient monitoring, with consideration for patient travel and social circumstances. [9] Evaluation of the impact of FN on health care utilization in the United States (US) could lead to improved insight into both hospital-and patient-level factors that impact length of stay.…”

Mise en place de recommandations thérapeutiques pour la prise en charge des neutropénies fébriles chez les enfants atteints de cancer : expérience du RIFHOP

“…. [20][21][22][23][24]. Dans notre étude, nous avons choisi de proposer un relais de l'antibiothérapie par voie orale à H72, malgré la persistance de la neutropénie, en l'absence de fièvre et de documentation bactériologique chez un enfant en bon état général compliant à la prise orale des antibiotiques et pour lequel la PCT était infé-rieure à 0,12 mg/L au moment de la prise en charge de la NF.…”

Neutropenia in the Febrile Child

“…16 This recommendation is based on a review of 16 mostly small single-center prospective trials of pediatric low-risk febrile neutropenia that found no increase in treatment failure and when outpatient treatment was compared with inpatient management and found no infection-related deaths in patients that were treated as outpatients. 37 In addition, research comparing parental and oral antibiotic therapy in low-risk febrile neutropenia patients found no difference in treatment failure and no infection-related deaths. 37 Oral antibiotics used in these studies were either fluoroquinolone monotherapy, fluoroquinonlone and amoxicillin-clavulanate, or cefixime monotherapy.…”

“…37 In addition, research comparing parental and oral antibiotic therapy in low-risk febrile neutropenia patients found no difference in treatment failure and no infection-related deaths. 37 Oral antibiotics used in these studies were either fluoroquinolone monotherapy, fluoroquinonlone and amoxicillin-clavulanate, or cefixime monotherapy. 37 The research suggests that there may be certain subpopulations of low risk febrile neutropenia oncology patients in whom early discharge off antibiotics is safe, but ongoing research needs to be performed.…”

“…37 Oral antibiotics used in these studies were either fluoroquinolone monotherapy, fluoroquinonlone and amoxicillin-clavulanate, or cefixime monotherapy. 37 The research suggests that there may be certain subpopulations of low risk febrile neutropenia oncology patients in whom early discharge off antibiotics is safe, but ongoing research needs to be performed. For patients who have fever and only mild or moderate neutropenia and no percutaneous central venous catheter, one may consider empiric therapy with ceftriaxone with discharge and outpatient follow-up pending culture results.…”