Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection.

@article{Santolaya2004EarlyHD,
  title={Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection.},
  author={Mar{\'i}a E. Santolaya and Ana Mar{\'i}a {\'A}lvarez and Carmen Luz Avil{\'e}s and Ana Becker and Jos{\'e} Cofr{\'e} and Miguel Angel Cumsille and Miguel O'Ryan and Ernesto Pay{\'a} and Carmen Salgado and Pamela Silva and Juan Tordecilla and M{\'o}nica Varas and Milena Villarroel and Tamara Viviani and Marcela Zubieta},
  journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
  year={2004},
  volume={22 18},
  pages={
          3784-9
        }
}
PURPOSE To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI). PATIENTS AND METHODS Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and… 

Tables from this paper

Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection.

Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.

Admission Clinical and Laboratory Factors Associated With Death in Children With Cancer During a Febrile Neutropenic Episode

Early clinical and laboratory findings significantly associated with death occurring at a later stage are identified and may prove to be useful in the early identification of children with a high-risk FN episode at risk for death.

Outpatient management of febrile neutropenia: time to revise the present treatment strategy.

Outdoor management of adult cancer patients with low-risk febrile neutropenia is safe, effective, and comparable to standard hospital-based therapy.

Very early discharge versus early discharge versus non-early discharge in children with cancer and febrile neutropenia.

This study found no clear evidence of difference in treatment failure in children with cancer and febrile neutropenia, and graded the evidence as low quality; the evidence was downgraded for risk of bias and imprecision.

Feasibility of withholding antibiotics in selected febrile neutropenic cancer patients.

This risk assessment model appears to identify febrile neutropenia patients at low risk for bacterial infection and can be withheld in well-defined neutropenic patients with fever.

Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer

Clinical data suggest, however, that outpatient management might be a safe and efficacious alternative for patients with low-risk FN episodes, and the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences.

Systematic review of reduced therapy regimens for children with low risk febrile neutropenia

Reduced intensity therapy for specified groups is safe with low rates of treatment failure, and services should consider how these can be acceptably implemented.

Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis.

Outpatient treatment of FN is a safe and efficacious alternative to inpatient management, and variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.

Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy.

There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment for febrile neutropenic patients, as there was no difference in the outcome in oral vs. intravenous therapy.

Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

Outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible, based on the combination of results from all prospective studies to date.
...

References

SHOWING 1-10 OF 26 REFERENCES

Discontinuation of antimicrobial therapy for febrile, neutropenic children with cancer: a prospective study.

For children with cancer as well as episodes of fever and neutropenia without an identifiable bacterial etiology at admission, stopping antibiotic therapy on day 3 was safe and not associated with a higher risk of bacterial superinfections.

Safety of early hospital discharge of selected febrile children and adolescents with cancer with prolonged neutropenia.

This study confirms that low-risk criteria used to select children with cancer for discharge before complete resolution of neutropenia can be safely applied to those patients whose neutropania lasted more than 7 days following admission.

Early discharge of low-risk febrile neutropenic children and adolescents with cancer.

Early discharge of febrile neutropenic children with cancer who met low-risk criteria fared well during their second hospitalization was safe and resulted in substantial cost savings.

Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial.

Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).

Oral cefixime is similar to continued intravenous antibiotics in the empirical treatment of febrile neutropenic children with cancer.

  • J. ShenepP. Flynn K. Slobod
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2001
Results support the safety of oral cefixime therapy for low-risk febrile neutropenic children, a therapeutic approach that would facilitate earlier outpatient management and decrease the costs of treatment.

"Low-risk" prediction rule for pediatric oncology patients presenting with fever and neutropenia.

Pediatric oncology outpatients with fever and neutropenia who present with an initial monocyte count of >/= 0.1 x 10(9)/L and do not have comorbidity or an abnormal CXR at the time of presentation are at lower risk for SBI and can be considered for less aggressive initial therapy.

Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia.

A risk prediction model for invasive bacterial infection was prospectively evaluated among children presenting with cancer, fever, and neutropenia and identified 5 risk factors during the first 24 h of hospitalization that were helpful in discriminating between children with a high or low risk for IBI.

A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy.

In hospitalized low-risk patients who have fever and neutropenia during cancer chemotherapy, empirical therapy with oral ciprofloxacin and amoxicillin-clavulanate is safe and effective.

Cessation of Antibiotics Regardless of ANC Is Safe in Children with Febrile Neutropenia: A Preliminary Prospective Trial

Results of this preliminary trial suggest that cessation of antibiotics regardless of ANC is safe in cases of FN without identifiable source, provided that marrow is not infiltrated and that recurrent fever receives prompt antibiotic retreatment.

Risk assessment and risk-based therapeutic strategies in febrile neutropenia

  • W. Kern
  • Medicine
    Current opinion in infectious diseases
  • 2001
Estimation of the risk of fungal infection by using clinical criteria, imaging and laboratory studies, as well as the identification of those patients likely to benefit from antifungal therapy, appear to be of critical importance.