Domiciliary treatment of febrile episodes in cancer patients: a prospective randomized trial comparing oral versus parenteral empirical antibiotic treatment

Hospitalization and empirical broad-spectrum, intravenous antibiotics are t he standard treatment for febrile cancer patients. Recent evidence supports the suggestion that febrile episodes in a low-risk population can be manag ed successfully in an outpatient setting, but the optimal drug regimen is u nknown. In a prospective randomized clinical trial we compared ciprofloxaci n 750 mg p.o. twice a day with ceftriaxone 2 g i.v. as a single daily dose for the empiric domiciliary treatment of febrile episodes in low-risk neutr openic and nonneutropenic cancer patients, A total of 173 patients, account ing for 183 febrile episodes, were enrolled in the study. Overall, successf ul outcomes were recorded for 76 of 93 (82%) febrile episodes in patients w ho were randomized to the oral regimen and for 68 of 90 (75%) febrile episo des in patients randomized to the i.v. regimen: this difference was not sta tistically significant, The success rate was similar in all subgroups of pa tients: neutropenic and nonneutropenic, with documented infection and with fever of unknown origin. There were 3 deaths in the group of patients treat ed with the parenteral regimen, and two of these were related to treatment failure. Both treatments were well tolerated, and the cost of the oral regi men was lower. This prospective study suggests that domiciliary antibiotic empiric monotherapy is feasible in febrile nonneutropenic or low-risk neutr openic outpatients in whom a bacterial infection is suspected, and that eit her an oral or a parenteral regimen can be used. A number of factors may in fluence the choice between an orally and an i.v.-administered antibiotic, b ut owing to the easier administration and lower cost, the oral regimen seem s to be preferable.