Oral Step-Down Therapy With Levofloxacin for Febrile Neutropenia in Children With Cancer

• Published in: Journal of the Pediatric Infectious Diseases Society 2021-02, Vol.10 (1), p.27-33
• Main Authors: Olson, Jared, Mehra, Sonia, Hersh, Adam L, Thorell, Emily A, Stoddard, Gregory J, Maese, Luke, Barnette, Phillip E, Lemons, Richard S, Pavia, Andrew T, Knackstedt, Elizabeth D
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Administration, Oral; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Chemotherapy-Induced Febrile Neutropenia - drug therapy; Child; Child, Preschool; Female; Humans; Levofloxacin - administration & dosage; Levofloxacin - therapeutic use; Male; Neoplasms - complications; Neoplasms - drug therapy
• ISSN: 2048-7207; 2048-7207
• DOI: 10.1093/jpids/piaa015

Abstract Background Although febrile neutropenia (FN) is a frequent complication in children with cancer receiving chemotherapy, there remains significant variability in selection of route (intravenous [IV] vs oral) and length of therapy. We implemented a guideline with a goal to change practice from using IV antibiotics after hospital discharge to the use of step-down oral therapy with levofloxacin for most children with FN until absolute neutrophil count > 500. The objectives of this study were to determine the impact of this guideline on home IV antibiotic use, and to evaluate the safety of implementation of this guideline. Methods We performed a quasi-experimental, pre–post study of discharge FN treatment at a stand-alone children’s hospital in patients without bacteremia discharged between January 2013 and October 2018. In January 2015, a multidisciplinary team created a guideline to switch most children with FN to oral levofloxacin, which was formally implemented as of September 2017. Discharges during the postintervention period (after September 2017) were compared to discharges in the preintervention period (between January 2013 and December 2014). Results In adjusted multivariable regression analyses, the postimplementation period was associated with a decrease in home IV antibiotics (adjusted risk ratio [aRR], 0.07 [95% confidence interval {CI}, .03–.13]) and fewer IV antibiotic initiations within 24 hours of a new healthcare encounter up to 7 days after discharge (aRR, 0.39 [95% CI, .17–.93]) compared to the preintervention time period. Conclusions Step-down oral levofloxacin for children with FN who are afebrile with an ANC ≤ 500 at discharge is feasible and resulted in similar clinical outcomes compared to home IV antibiotics. Step-down oral levofloxacin for children with FN who are afebrile with negative blood cultures and an ANC ≤ 500 at discharge is feasible and resulted in similar clinical outcomes compared to home IV antibiotics.