Short-course antibiotics for chemotherapy-induced febrile neutropaenia: retrospective cohort study
- 1 September 2020
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 105 (9), 881-885
- https://doi.org/10.1136/archdischild-2019-317908
Abstract
Background Recent 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. Methods Patients 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. Results 179 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. Conclusion This paper indicates that the policy described provides a balance between safety and acceptability. Further work is needed to demonstrate non-inferiority and cost-benefit.This publication has 19 references indexed in Scilit:
- Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children’s Oncology GroupBlood, 2013
- Updated Systematic Review and Meta-Analysis of the Performance of Risk Prediction Rules in Children and Young People with Febrile NeutropeniaPLOS ONE, 2012
- Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trialsSupportive Care in Cancer, 2012
- Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol)Systematic Reviews, 2012
- 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 studyPediatric Blood & Cancer, 2012
- Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancerBMC Medicine, 2012
- Parental Perspectives on Inpatient Versus Outpatient Management of Pediatric Febrile NeutropeniaJournal of Pediatric Oncology Nursing, 2011
- Predicting Adverse Events in Children With Fever and Chemotherapy-Induced Neutropenia: The Prospective Multicenter SPOG 2003 FN StudyJournal of Clinical Oncology, 2010
- Variation in policies for the management of febrile neutropenia in United Kingdom Children's Cancer Study Group centresArchives of Disease in Childhood, 2007
- The evolution towards ambulatory and day‐case management of febrile neutropeniaBritish Journal of Haematology, 2006