Reatment of Febrile Neutropenia in Pediatric Cancer Patients. A Clinical Evaluation of Effectiveness of Emperical Oral Antibiotic Therapy

Abstract

Introduction: Febrile neutropenia in cancer patients represents a common complication from chemotherapy that is potentially lethal. However in patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods: We conducted a prospective hospital based study to the patients aged 2-14 years who had fever and neutropenia during cancer chemotherapy for both hematological and solid tumors. Only low risk patients i.e. neutropenia of less than seven days, who were hemodynamically stable and ANC >250/mm 3 were included in the study. All the patients followed Guidelines for pre-treatment assessments and investigations before they were hospitalized and given oral antibiotic ofloxacin and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results: A total of 92 cases were enrolled in the study. Out of 92 patients 1 patient was lost to follow-up, 14 needed IV antibiotics for different reasons and 74 patients (80%) improved well with oral antibiotic only. The events that led to changing the treatment regimen were: grade III/IV vomiting (two cases), fever lasting for more than 72 hours (seven episodes), severe mucositis (one episode), anal cellulitis (one episode) and no obvious cause (three episodes). Conclusion: In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin may be a safe and effective alternative to IV antibiotics. Further study should be aimed at clarifying the definition of low risk pediatric patients.