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Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients
Author(s) -
Mullen Craig A.,
Petropoulos Demetrios,
Roberts W. Mark,
Rytting Michael,
Zipf Theodore,
Chan Ka Wah,
Culbert Steven J.,
Danielson Martha,
Jeha Sima S.,
Kuttesch John F.,
Rolston Kenneth V.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990701)86:1<126::aid-cncr18>3.0.co;2-1
Subject(s) - medicine , neutropenia , mucositis , febrile neutropenia , surgery , chemotherapy , pediatrics
BACKGROUND Fever and neutropenia (F&N) is a common complication of cancer chemotherapy. It is conveniently managed by hospitalization and empiric administration of parenteral antibiotics. This study attempted to determine whether pediatric cancer patients with F&N identified as low risk for morbidity and mortality by clinical criteria at the time of presentation could be treated safely as outpatients. METHODS Seventy‐three episodes of F&N in 41 patients were studied prospectively over 2 years. Eligibility criteria included age ≥2 years, reliable caretakers, and residence within 1 hour of the hospital. Exclusion criteria included hemodynamic instability, dehydration, severe mucositis, pneumonia, leukemia/lymphoma induction therapy, bone marrow transplantation, or other serious comorbidity. Patients were evaluated, received a single dose of intravenous ceftazidime, and were observed for 3–16 hours. They were randomized to receive either oral ciprofloxacin or intravenous ceftazidime as outpatients. Patients were seen daily until they had been afebrile for at least 48 hours and had a rising absolute phagocyte count of >500 cells/μL. RESULTS Sixty‐three of 73 episodes (86%) were successfully managed on an outpatient basis. For 31 of 33 episodes in the ceftazidime arm, the patients remained outpatients, compared with 32 of 40 in the ciprofloxacin arm; this difference was not statistically significant. On average, patients remained febrile for 2.7 days and were treated for 4.7 days. Seventy‐seven percent of episodes required no modification of initial antibiotic therapy. Of the 10 patients who were hospitalized, 4 had prolonged fever and 3 had emesis. Protracted neutropenia was associated with the need for hospitalization. There were no deaths, intensive care unit transfers, or serious complications. CONCLUSIONS Carefully selected low risk children with fever and neutropenia can be treated safely as outpatients. Close daily medical scrutiny is required. Cancer 1999;86:126–34. © 1999 American Cancer Society.