Variation in policies for the management of febrile neutropenia in United Kingdom Children's Cancer Study Group centres

Phillips, Bob; Selwood, Karen; Lane, Sheila; Skinner, Roderick; Gibson, Faith; Chisholm, Julia

doi:10.1136/adc.2006.102699

Cited by 61 publications

(63 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Correspondingly, there is no consensus on when step-down from standard treatment is safe and efficacious [9]. This lack of consensus leads to important variations in management of FN, and thus safety, resource utilization, and patient's quality of life, between different institutions [10,11]. In many institutions, stepping-down late, that is, after 2-4 days from presentation with FN, but before resolution of neutropenia, is established for patients with a favorable course of FN [11].…”

Section: Introductionmentioning

confidence: 99%

“…This lack of consensus leads to important variations in management of FN, and thus safety, resource utilization, and patient's quality of life, between different institutions [10,11]. In many institutions, stepping-down late, that is, after 2-4 days from presentation with FN, but before resolution of neutropenia, is established for patients with a favorable course of FN [11]. For early or first-day stepping-down from intravenous to oral antimicrobial therapy, four single-center randomized controlled trials (RCT) did not find differences regarding efficacy or safety in low-risk FN [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Brack

Bodmer

Simon

et al. 2012

Pediatric Blood & Cancer

View full text Add to dashboard Cite

BackgroundThe standard treatment of fever in chemotherapy‐induced neutropenia (FN) includes emergency hospitalization and empirical intravenous antimicrobial therapy. This study determined if first‐day step‐down to oral outpatient treatment is not inferior to continued standard regarding safety and efficacy in children with low‐risk FN.ProcedureIn a randomized controlled non‐blinded multicenter study, pediatric patients with FN after non‐myeloablative chemotherapy were reassessed after 8–22 hours of inpatient intravenous antimicrobial therapy. Low‐risk patients were randomized to first‐day step‐down to experimental (outpatient, oral amoxicillin plus ciprofloxacin) versus continued standard treatment. Exact non‐inferiority tests were used for safety (no serious medical complication; non‐inferiority margin of difference, 3.5%) and efficacy (resolution of infection without recurrence, no modification of antimicrobial therapy, no adverse event; 10%).ResultsIn 93 (26%) of 355 potentially eligible FN episodes low‐risk criteria were fulfilled, and 62 were randomized, 28 to experimental (1 lost to follow‐up) and 34 to standard treatment. In intention‐to‐treat analyses, non‐inferiority was not proven for safety [27 of 27 (100%) vs. 33 of 34 (97%; 1 death) episodes; 95% upper confidence border, 6.7%; P = 0.11], but non‐inferiority was proven for efficacy [23 of 27 (85%) vs. 26 of 34 (76%) episodes; 95% upper confidence border, 9.4%; P = 0.045]. Per‐protocol analyses confirmed these results.ConclusionsIn children with low‐risk FN, the efficacy of first‐day step‐down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non‐inferior to continued hospitalization and intravenous antimicrobial therapy. The safety of this procedure, however, was not assessable with sufficient power. Pediatr Blood Cancer 2012;59:423–430. © 2012 Wiley Periodicals, Inc.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Brack

Bodmer

Simon

et al. 2012

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…There has been increasing interest in stratifying these patients into risk categories to establish guidelines for better management [7,[12][13][14]. The current study uses a single institution database to identify the risk factors for development of adverse outcomes among PCP with PFN.…”

Section: Discussionmentioning

confidence: 99%

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Matloob¹

2016

Journal of Microbiology and Infectious Diseases

View full text Add to dashboard Cite

Objective: Pediatric cancer patients with prolonged febrile neutropenia have increased risk for severe, recurrent or new bacterial and fungal infection. The aim of this study was to identify the risk factors associated with adverse outcomes in this group. Methods:We retrospective analyzed the clinical data of 135 hospitalizations of pediatric cancer patients with prolonged febrile neutropenia from a tertiary health care center of Pakistan. Results:The mean age of the study population was 7.3±4.1 years. There were 98 (72.6%) males and 37 (27.4%) females. Acute leukemia with 88 patients (65.2%) was the most common diagnosis followed by lymphomas 19 patients (14.1%) and solid tumors. Cause of febrile neutropenia was identified in only 58 (43.0%) patients, out of them blood stream infections were found in 22 cases (16.3%), pneumonia in 15 (11.1%), fungal infection in 13 (9.6%), infectious diarrheas in 5 (3.7%) and urinary tract infection (UTI) in 3 (2.2%) of cases. The composite adverse event outcome was observed in 28 (20.7%) of patients, with in-hospital mortality occurring in 7 (5.2%), Pediatric intensive care unit (PICU) admission occurring in 12 (8.9%) and inotropic support was required in 9 (6.7%). On logistic regression analysis AML (Adjusted odds ratio (AOR), 7.6; P<0.001), neutropenia <50/mm 3 (AOR, 10.8; p<0.001), platelets count <50,000/mm 3 (AOR, 5.2; p<0.001), BSI (AOR, 2.3; p 0.05) and fungal infection (AOR, 4.3; p<0.001) were found as independent risk factors for composite adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia.Conclusions: AML, severe myelosuppression, blood stream infections and fungal infection were identifiable risk factors associated with development of adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia. J Microbiol Infect Dis 2016;6(2): 69-73Key words: Febrile neutropenia, pediatric, oncology, adverse outcome Uzamış Febril Nötropeni ile Pediatrik Kanser Hastalarında Karma Olumsuz Durum SonuÖZET Amaç: Uzamış febril nötropeni pediatrik kanserli hastalarında ağır seyirli yeni tanı veya tekrarlayan bakteri ve mantar enfeksiyonu riski artmıştır. Bu çalışmanın amacı, bu grupta olumsuz sonuçlarla ilişkili risk faktörlerini belirlemektir.Yöntemler: Pakistan'ta bir üçüncü basamak sağlık merkezine uzamış febril nötropeni nedeni ile izlenen pediatrik kanser hastalarının 135 hastane yatış epizotu retrospektif olarak analiz edildi. Bulgular: Çalışma grubunun yaş ortalaması 7,3 ± 4,1 yıl idi. Hastaların 98'i (% 72,6) erkek ve 37'si (% 27,4) kadındı. Akut lösemi 88 hastada (% 65,2) ile birinci sırada, lenfoma 19 hasta (% 14,1) ile ikinci sırada idi ve diğer hastalarda solid organ tümörleri en sık görülen tanı olarak saptandı. Febril nötropenin nedeni sadece 58 (% 43,0) hastada tanımlandı. Bu hastalardan 22 olguda (% 16,3) kan akımı enfeksiyonu (KAE), 15 hastada pnömoni (% 11,1), fungal infeksiyon 13 (% 9,6) hastada, ve enfeksiyöz diyare 5 hastada (% 3,7) ve üriner sitem enfeksiyonu 3 (% 2,2) hastada saptandı. Karma olumsu...

show abstract

“…However, the accuracy study, and other studies, revealed no consensus about what treatment should be given. 29 We found wide variation in the types of CVC-targeted treatment offered and which children were treated. For example, the duration of 'CVC-targeted' treatment (e.g.…”

Section: Overview Of the Studymentioning

confidence: 99%

“…29 In view of the lack of evidence to support the treatment options considered in this study, there is no evidence to recommend approaches to management other than the use of antibiotic locks for prophylaxis.…”

Section: Implications For Practicementioning

confidence: 99%

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

Millar

Zhou²,

Skinner³

et al. 2011

Health Technol Assess

View full text Add to dashboard Cite

How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. ii ii HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of pro...

show abstract

Variation in policies for the management of febrile neutropenia in United Kingdom Children's Cancer Study Group centres

Cited by 61 publications

References 10 publications

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

Contact Info

Product

Resources

About