NEW STRATEGIES IN THE TREATMENT OF INFECTIOUS COMPLICATIONS IN HEMATOLOGY AND ONCOLOGY - IS THERE A ROLE FOR OUTPATIENT ANTIBIOTIC-TREATMENT OF FEBRILE NEUTROPENIA

Febrile neutropenia is associated with a significant risk of complicat ions and mortality. Patients with neutropenia secondary to cytostatic chemotherapy who develop fever are normally admitted to hospital and t reated promptly with broad-spectrum antibiotics. Over the last 10 year s, chemotherapy for solid tumours has been shifting out of the hospita l setting into the ambit of community-based oncologists, and out-patie nt treatment with complex multidrug protocols is becoming increasingly common. In North America high-dose protocols combined with peripheral blood stem cell transfusion are already being administered on an out- patient basis. With the increase in the numbers of out-patients underg oing multidrug chemotherapy, there has been a corresponding rise in th e severity and duration of neutropenia and in the incidence of associa ted infections. Patients with neutropenia of short duration (<7 days) and fever are at a relatively low risk for complications, and in these circumstances, outpatient antibiotic treatment is an alternative to c ostly hospitalisation. Drugs, whose antimicrobial coverage and pharmac okinetics make them particularly suitable for out-patient treatment of febrile neutropenia, include intravenous and oral quinolones and, for once-daily dosing, intravenous glycopeptides, ceftriaxone and intrave nous aminoglycosides. Response rates of 60-95% have been achieved with such regimens in clinical trials, with hospital admission avoided in 75-95% of the cases. There is no doubt that out-patient treatment impr oves the quality of life of cancer patients. In Europe, however, there is a need for randomised clinical trials to support the establishment of out-patient-based treatment of febrile neutropenia. Out-patient an tibiotic treatment of febrile neutropenia is still not standard practi ce, and community-based providers of such treatment must be adequately equipped and experienced in the management of this condition.