Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial

Abstract

This randomized controlled trial (RCT) [1] compared outpatient versus inpatient antibiotic therapy in a group of children presenting with low risk febrile neutropenia against a background of hematological malignancies. The investigators focused on Quality of Life (QoL) using a 13-point scale, and efficacy of treatment. Children (1–21 y) receiving chemotherapy for acute leukemia or solid tumors at a tertiary care hospital in Melbourne, who presented with fever (defined appropriately) were administered one dose of intravenous cefipime pending the neutrophil count. Those with confirmed neutropenia (<500/mm3) and a low-risk status (defined as absence of septic shock or comorbidities requiring hospitalization) were randomized to receive outpatient or inpatient intravenous cefipime 12 hourly until a positive blood culture became available or the clinical condition warranted change in management. Parents and children in the outpatient arm had better QoL scores for almost all items (although many did not achieve statistical significance), and no significant difference in treatment duration, fever duration, microbiologically proven infection, identified focus of infection, or complications. Six episodes in the outpatient arm required readmission to hospital.