OUTPATIENT ANTIBIOTIC-TREATMENT IN LOW-RISK FEBRILE NEUTROPENIC CANCER-PATIENTS

Traditionally febrile neutropenic patients have been treated with pare nteral antibiotics in an inpatient setting; however, recent work by se veral investigators has demonstrated successful treatment with both pa renteral and oral antibiotics in an ambulatory environment. This has b een accomplished by identification of low-risk neutropenic patients, a dvances in broad-spectrum antibiotics with long half-lives and stabili ties, the introduction of the oral quinolones, home health-care initia tives, improvements in vascular access devices, and development of tec hnically enhanced antibiotic delivery systems. Outpatient antibiotic t herapy for febrile episodes in low-risk neutropenic patients should no w be considered an acceptable alternative to hospital-based treatment. This review focuses on the development and rationale of risk stratifi cation and examines the results of various outpatient antibiotic trial s recently completed.