EARLY DISCHARGE OF PEDIATRIC FEBRILE NEUTROPENIC CANCER-PATIENTS BY SUBSTITUTION OF ORAL FOR INTRAVENOUS ANTIBIOTICS

In an open, prospective pilot study of pediatric cancer patients, 23 e pisodes of fever and neutropenia were treated with intravenous and the n oral antibiotics. After 72 hours, patients were changed from intrave nous to oral antibiotics if the following criteria were met: negative blood cultures, temperature 38.0-degrees-C or lower for 24 hours, abso lute neutrophil count less than 0.5 X 10(9)/L, and absence of clinical sepsis. Three patients (13 %) had recurrent fever. Intravenous antibi otics were reinstituted in two of these three patients, and oral antib iotics were continued in the third. Fever was believed to be related t o relapsed leukemia in one of the three patients. No focus of infectio n was defined in the other two, and both had good clinical outcomes. T he study suggests that this approach to therapy is feasible and can be safely used for selected patients who are anticipated to have a short duration of neutropenia.