OUTPATIENT ANTIMICROBIAL PROTOCOL FOR FEBRILE NEUTROPENIA - A NONRANDOMIZED PROSPECTIVE TRIAL USING CEFTRIAXONE, AMIKACIN, AND ORAL ADJUVANT AGENTS

Broad-spectrum antimicrobial therapy has revolutionized the management of febrile neutropenia (FN) in cancer patients. In vogue is an effect ive therapy on an outpatient basis. One thousand three hundred episode s of FN observed in 70 pediatric solid tumors (STs) and 65 cases of he matomalignancy (HM) at a median age of 5.5 years were treated with a p rotocol using once-a-day injectable ceftriaxone plus amikacin and othe r oral adjuvant antimicrobial agents. The mean duration of FN in the S T group was 4.0 +/- 1.2 days and in the HM group was 5.0 +/- 2.5 days. The mean duration of antimicrobial cover in the ST group was 5.0 +/- 1.75 days and in the HM group was 6.0 +/- 1.5 days. The overall recrud escence rate was 6% and the mean duration to recrudescence was 4 +/- 1 .5 days (range 3-6 days). The objectives of this protocol were cost re duction and utilization of the available inpatient resources optimally by reducing the pressures of hospitalization for febrile neutropenia. We concluded that a selected group of patients with FN can be effecti vely managed with this regimen on an outpatient basis.