OUTPATIENT TREATMENT OF FEBRILE EPISODES IN LOW-RISK NEUTROPENIC PATIENTS WITH CANCER

Background. Hospitalization and intravenous (IV) broad-spectrum antibi otics are the standard of care for all febrile neutropenic patients wi th cancer. Recent work suggests that a low-risk population exists who might benefit from an alternate approach. Methods. A prospective rando mized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clin damycin 600 mg every 8 hours for the empiric outpatient treatment of f ebrile episodes in low-risk neutropenic patients with cancer. Results. The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than tha t of the IV regimen (P < 0.0001), it was associated with significant r enal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superi or (P = 0.03). Conclusions. This prospective study suggested that outp atient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.