Outpatient Management of Febrile Neutropenia in Children with Cancer
- 1 January 2003
- journal article
- review article
- Published by Springer Science and Business Media LLC in Pediatric Drugs
- Vol. 5 (7), 443-455
- https://doi.org/10.2165/00128072-200305070-00002
Abstract
The objectives of this article are to review the studies that have examined the safety and feasibility of outpatient management for children with febrile neutropenia, and to provide recommendations as to which patient populations and treatment strategies are most appropriate for this approach. The outpatient strategies have included either complete outpatient management or employment of early discharge, with the latter methodology predominating in most published studies. Common criteria relied upon to identify children with febrile neutropenia at low risk of serious infections included evidence of hematopoietic recovery and/or an absolute monocyte count ≥100/mm3, and the absence of both comorbidity and culture positivity. A wide variety of different antibacterial regimens have been employed, with some trials investigating either early discontinuation of treatment or conversion to an oral administration strategy. Trials performed to date among this low risk population indicate a very low rate of readmission and/or complications. Some studies have also estimated substantial overall cost savings with this approach. However, many of these trials are significantly underpowered to detect the low rate of serious complications in the pediatric population with febrile neutropenia. At present, the available evidence indicates that a carefully chosen subpopulation of children with febrile neutropenia can be safely managed on an outpatient basis. Regardless of setting, current clinical guidelines for febrile neutropenia management indicate that all children with febrile neutropenia should be managed with appropriate antibacterial therapy until resolution of febrile neutropenia. Treatment with either an oral antibacterial regimen as initial therapy, or early discontinuation of antibacterial therapy in the outpatient setting should remain investigational at the present time.Keywords
This publication has 39 references indexed in Scilit:
- 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with CancerClinical Infectious Diseases, 2002
- Fever and neutropenia in children with solid tumors is similar in severity and outcome to that in children with leukemiaSupportive Care in Cancer, 2002
- Oral Cefixime Is Similar to Continued Intravenous Antibiotics in the Empirical Treatment of Febrile Neutropenic Children with CancerClinical Infectious Diseases, 2001
- Early Hospital Discharge of Children with Fever and NeutropeniaJournal of Pediatric Hematology/Oncology, 1997
- A pilot study of outpatient management of febrile neutropenic children with cancer at low risk of bacteremiaThe Journal of Pediatrics, 1996
- Cessation of Antibiotics Regardless of ANC Is Safe in Children with Febrile NeutropeniaJournal of Pediatric Hematology/Oncology, 1995
- Early Discharge Of Pediatric Febrile Neutropenic Cancer Patients By Substitution Of Oral For Intravenous AntibioticsPediatric Hematology and Oncology, 1994
- Safety and efficacy of ciprofloxacin in paediatric patients — ReviewInfection, 1993
- The child with cancer and infection. I. Empiric therapy for fever and neutropenia, and preventive strategiesThe Journal of Pediatrics, 1991
- Evaluation of a Home Intravenous Antibiotic Program in Pediatric OncologyJournal of Pediatric Hematology/Oncology, 1991