AMBULATORY TREATMENT WITH CEFTRIAXONE IN FEBRILE NEUTROPENIC CHILDREN

We conducted a prospective nonrandomized study of outpatient therapy w ith ceftriaxone as a single agent in 50 episodes of fever and neutrope nia in children treated with various myelosuppressive regimens for dif ferent malignancies. All patients underwent clinical and radiological evaluation and blood/urine cultures taken before starting therapy. Pat ients with dehydration, hypotension, rigor and clinical exit-site infe ction of indwelling right-sided catheters were excluded. Forty-one pat ients completed an antibiotic course of 7 days: in 12 patients fever r eturned to normal on day 2, in 10 patients on day 3, and in 8 patients on day 4. The duration of neutropenia following the initial febrile e pisode was 3-10 days. In some patients fever returned to normal after 2 days, but neutropenia persisted up to 10 days. Two patients were bac teremic - Escherichia coli in one, and Acinetobacter/Staphylococcus co agulase negative in another; all isolates were sensitive to ceftriaxon e. In nine episodes, antimicrobial therapy was modified because of per sistent fever >39 degrees C in five patients, bacteremia in two, enter ocolitis in one, breakthrough fever in two, and bronchopneumonia in on e. The low incidence of bacterial isolation is probably attributed to the selection of patients with low risk features. Patients and parents complied with and favored outpatient therapy to hospitalization.