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

Background There is no consensus on whether therapeutic intensity can be reduced safely in children with low-risk febrile neutropenia (FN). Our primary objective was to determine whether there is a difference in efficacy between outpatient and inpatient management of children with low-risk FN. Our s...

Full description

Saved in:
Bibliographic Details
Published in:Supportive care in cancer 2012-06, Vol.20 (6), p.1135-1145
Main Authors: Manji, A., Beyene, J., Dupuis, L. L., Phillips, R., Lehrnbecher, T., Sung, L.
Format: Article
Language:English
Subjects:
Administration, Oral
Ambulatory Care
Anti-Bacterial Agents - administration & dosage
Antibiotics
Cancer
Chemotherapy
Child
Children & youth
Fever - drug therapy
Fever - etiology
Health aspects
Humans
Leukocytes
Medicine
Medicine & Public Health
Mortality
Neoplasms - drug therapy
Neutropenia
Neutropenia - drug therapy
Neutropenia - etiology
Nursing
Nursing Research
Oncology
Pain Medicine
Pediatrics
Rehabilitation Medicine
Review Article
Risk Factors
Side effects
Systematic review
Treatment Failure
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background There is no consensus on whether therapeutic intensity can be reduced safely in children with low-risk febrile neutropenia (FN). Our primary objective was to determine whether there is a difference in efficacy between outpatient and inpatient management of children with low-risk FN. Our secondary objective was to compare oral and parenteral antibiotic therapy in this population. Methods We performed electronic searches of Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in low-risk FN. Percentages were used as the effect measure. Results From 7,281 reviewed articles, 16 were included in the meta-analysis. Treatment failure, including antibiotic modification, was less likely to occur in the outpatient setting compared with the inpatient setting (15 % versus 28 %, P  = 0.04) but was not significantly different between oral and parenteral antibiotic regimens (20 % versus 22 %, P  = 0.68). Of the 953 episodes treated in the outpatient setting and 676 episodes treated with oral antibiotics, none were associated with infection-related mortality. Conclusion Based on the combination of results from all prospective studies to date, outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-012-1425-8