USE OF FLUOROQUINOLONES FOR EMPIRICAL MANAGEMENT OF FEBRILE NEUTROPENIA IN PEDIATRIC CANCER-PATIENTS

Background. Empiric antibiotic therapy has become a standard of care f ar the febrile neutropenic patient. Many clinical trials over the prev ious three decades have demonstrated that a variety of antibiotic comb inations and more recently potent antibiotic monotherapies may preserv e the patient through the critical time of fever and neutropenia. Rece ntly attempts have been made to identify ''low risk'' patients who may not require traditional, intensive, hospitalized intravenous antimicr obial therapy. Therefore the need for new treatment alternatives for t he febrile neutropenic pediatric cancer patient in particular revolves around the desire for less complex regimens, agents with minimal toxi city and expense and the option of an oral formulation for outpatient management. Objective. Fluoroquinolones, especially ciprofloxacin and ofloxacin, are examined in this paper as potential oral alternatives f or managing the low risk neutropenic pediatric cancer patient populati on. Attention must be paid to their antibacterial spectra, however, an d in some cases fluoroquinolones should be combined with a second agen t for additional Gram-positive coverage. Results, Several studies, inc luding one ongoing trial at the National. Cancer Institute, have shown the potential benefits of oral fluoroquinolone therapy among low risk febrile neutropenic patients, joint complaints in children after cipr ofloxacin therapy in the National Cancer Institute trial thus far have been minimal, reversible and felt to be unrelated to ciprofloxacin tr eatment. Conclusion. The use of outpatient therapy, such as the fluoro quinolones, to manage febrile neutropenic episodes must be approached with caution and should be undertaken only in selected low risk patien ts.