Ceftriaxone plus once daily aminoglycoside with filgrastim for treatment of febrile neutropenia: Early hospital discharge vs. standard in-patient care

Background: In febrile neutropenic patients, ceftriaxone plus an aminoglyco side is effective for the treatment of infection, while filgrastim reduces the extent and duration of neutropenia. Because the once daily dosing regim en of this combination permits ambulatory treatment, there is a need to tes t criteria for early hospital discharge. Methods: Hospitalized adult patien ts with febrile neutropenia (following chemotherapy) considered to be poten tially treatable on a follow-up out-patient basis were entered into this op en-label, multinational study. Patients received a once daily combination o f ceftriaxone for greater than or equal to 5 days, aminoglycoside for great er than or equal to 2 days, and filgrastim until the absolute neutrophil co unt was greater than or equal to 1.0 x 10(9)/l for 2 days. Those initially responding to therapy (reduction of fever by greater than or equal to 1 deg rees C within 72 h, and clinical improvement) were randomized into standard in-patient or follow-up out-patient treatment groups, the latter patients being discharged from hospital early, after meeting defined criteria. Resul ts: 105 patients were enrolled, of whom 21 initial non-responders were not randomized. Efficacy was evaluable in 80 patients. Success (resolution of f ever and symptoms, maintained for 7 days after cessation of therapy, and er adication of infecting pathogens) was similar among inpatients (40/42, 95%) and out-patients (34/38, 89%). The duration of hospitalization was shorter for out-patients than in-patients (median of 4 vs. 6 days, respectively). No hospital readmissions were necessary in out-patients. All other efficacy parameters assessed were comparable in both groups, as was tolerability/sa fety. One potentially drug-related death was reported. Conclusions: Patient s who satisfy prospectively defined criteria for early discharge can be tre ated safely on an outpatient basis with a regimen of once daily ceftriaxone plus an aminoglycoside with filgrastim. In addition to reducing healthcare costs, it may im prove patients' quality of life. Copyright (C) 1999 S.Kar ger AG, Basel.