Short-course antibiotics for chemotherapy-induced febrile neutropaenia: retrospective cohort study

Abstract

BackgroundRecent research in febrile neutropaenia (FN) has focused on reducing the intensity of treatment for those thought to be at low risk of significant morbidity or mortality. This has not led to a reduced burden of treatment for either families or healthcare systems. An alternative approach is to discharge all patients who remain well after 48 hours of inpatient treatment, either with no ongoing treatment or with appropriate antibiotics if the cultures are positive. This paper aimed to demonstrate that this approach is safe.MethodsPatients treated according to this approach in a single centre were reviewed retrospectively, with a random selection of patients from a 4-year period. Data were collected according to the Predicting Infectious Complications of Neutropenic sepsis in Children with Cancer dataset. In addition, all septic deaths over a 10-year period were reviewed in the same manner.Results179 episodes of FN were reviewed from 47 patients. In 70% (125/179) of episodes, patients were discharged safely once 48-hour microbiology results were available, with only 5.6% (7/125) resulting in readmission in the 48 hours following discharge. There were no septic deaths in this cohort.There were 11 deaths due to FN over the 10-year study period. Almost all patients were identified as severely unwell in the early stages of their final presentation or had a prolonged final illness.ConclusionThis paper indicates that the policy described provides a balance between safety and acceptability. Further work is needed to demonstrate non-inferiority and cost–benefit.

Highlights from this issue

“…However, there remain a few (surprisingly) hard, tantalisingly prosaic, nuts to crack. We’ve previously reported on safe, admission-shortening short course alternatives to the time-honoured, morale-sapping, 5 day-long admissions for IV antibiotics in neutropenic though well, culture negative children 1. Arguably even more troublesome is the near ubiquitous mucositis which has spawned any number of ‘local’ remedies, cocktails of opiates, topical analgesics and disinfectants, each centre loyally sticking with their potion of tradition.…”