Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients

BACKGROUND. Fever and neutropenia (F&N) is a common complication of cancer chemotherapy. It is conveniently managed by hospitalization and empiric adm inistration of parenteral antibiotics. This study attempted to determine wh ether pediatric cancer patients with F&N identified as low risk for morbidi ty and mortality by clinical criteria at the time of presentation could be treated safely as outpatients. METHODS, Seventy-three episodes of F&N in 41 patients were studied prospect ively over 2 years. Eligibility criteria included age greater than or equal to 2 years, reliable caretakers, and residence within 1 hour of the hospit al. Exclusion criteria included hemodynamic instability, dehydration, sever e mucositis, pneumonia, leukemia/lymphoma induction therapy, bone marrow tr ansplantation, or other serious comorbidity. Patients were evaluated, recei ved a single dose of intravenous ceftazidime, and were observed for 3-16 ho urs. They were randomized to receive either oral ciprofloxacin or intraveno us ceftazidime as outpatients. Patients were seen daily until they had been afebrile for at least 48 hours and had a rising absolute phagocyte count o f >500 cells/mu L. RESULTS, Sixty-three of 73 episodes (86%) were successfully managed on an o utpatient basis. For 31 of 33 episodes in the ceftazidime arm, the patients remained outpatients, compared with 32 of 40 in the ciprofloxacin arm; thi s difference was not statistically significant. On average, patients remain ed febrile for 2.7 days and were treated for 4.7 days. Seventy-seven percen t of episodes required no modification of initial antibiotic therapy. Of th e 10 patients who were hospitalized, 4 had prolonged fever and 3 had emesis . Protracted neutropenia was associated with the need for hospitalization, There were no deaths, intensive care unit transfers, or serious complicatio ns. CONCLUSIONS. Carefully selected low risk children with fever and neutropeni a can be treated safely as outpatients. Close daily medical scrutiny is req uired. Cancer 1999;86:126-34, (C) 1999 American Cancer Society.