RISK-FACTORS FOR RECURRENT FEVER AFTER THE DISCONTINUATION OF EMPIRICANTIBIOTIC-THERAPY FOR FEVER AND NEUTROPENIA IN PEDIATRIC-PATIENTS WITH A MALIGNANCY OR HEMATOLOGIC CONDITION

We studied episodes of fever and neutropenia in children and adolescen ts without documented infections to determine the risk of recurrent fe ver after early discontinuation of empiric antibiotic therapy; 213 epi sodes occurred in 106 patients. All patients received empiric antibiot ic therapy after cultures were obtained. Antibiotic therapy was discon tinued if no infection was found, culture results were negative for 48 hours, and the patient was afebrile for 24 hours. In 83 episodes with out documented infection, antibiotic therapy was stopped with absolute neutrophil counts <0.5 X 10(9)/L (<500/mm(3)); 50 episodes occurred i n patients with solid tumors, leukemia in remission, and other hematol ogic conditions (group 1), and 33 in patients with active leukemia (gr oup 2). Fever recurred before neutropenia resolved in 6% of group 1 an d 45% of group 2 episodes; five patients in group 2 had documented inf ection. Recurrent fever risk correlated with absolute neutrophil count and monocyte count at the time antibiotic therapy was stopped, in bot h groups, as did increasing absolute neutrophil count and increasing l eukocyte count in group 2. We conclude that discontinuing antibiotic t herapy is safe in febrile episodes without documented infections befor e neutropenia resolves in patients with high potential for bone marrow recovery. The risk of recurrent fever and infection is significant fo r patients with neutropenia and poor marrow recovery potential.