CEFTRIAXONE MONOTHERAPY IN THE TREATMENT OF LOW-RISK FEBRILE NEUTROPENIA

Febrile neutropenia in patients who have undergone chemotherapy is usu ally treated with a combination of broad-spectrum antibiotics. There a re no exactly defined protocols for single-agent treatment because a c lear definition of low risk febrile neutropenia is lacking. This paper examines the safety and efficacy of once-daily ceftriaxone in 376 cas es. Material and Methods: In a prospective observational study carried out between February 1992 and January 1996, 959 febrile episodes at 4 8 hospitals were recorded. Inclusion criteria were neutropenia (absolu te neutrophil count, ANC <1,000/mu l) with fever(greater than or equal to 38.5 degrees C) or a C-reactive protein concentration >1 mg/dl and suspected infection. Nine hundred and one episodes (acute leukemia n = 396, lymphoma n = 220, solid tumors n = 272 and other disorders n = 13) in 828 patients aged between 1 and 97 years were analyzed, of whic h 876 episodes were evaluable for response. All patients initially und erwent empirical treatment with ceftriaxone (adults: 2 g/day; children : 80 mg/kg/day), either alone (376) or in combination with other agent s (525). Results: The mean ANC was 423/mu l (SD +/- 316) and the media n duration of neutropenia 10 days. Of the 363 episodes treated initial ly with ceftriaxone alone, 70.8% responded versus 56.9% in the combina tion therapy group. The favorable response to the initial monotherapy treatment was explained by a low-risk population in the monotherapy gr oup. A KI >6 (p < 0.0001), ANC greater than or equal to 500/mu l (p = 0.0001) and a duration of ANC < 5 days (p < 0.05) were significantly m ore frequent in the monotherapy arm and were predictive of lower risk at the commencement of treatment. Conclusion: Ceftriaxone is effective in febrile neutropenia. Treatment with ceftriaxone alone was safe and highly effective in low-risk patients. Single-agent regimens appear t o be a suitable treatment option in low-risk febrile neutropenia.