Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: Randomized prospective trial

Background. infections are one of the major complications in children under going chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymph omas). The same drugs may be used in an outpatient setting, decreasing cost s and the risk of nosocomial infections. Procedure. Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to rec eive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. O nly one patient had a central venous catheter. Results. Episodes of fever a nd neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceft riaxone groups, respectively. Most of these infections were of upper respir atory tract, skin, or gastrointestinal origin. The mean duration of neutrop enia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Th erapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived. Conclusions. Outp atient therapy with either oral ciprofloxacin or intravenous ceftriaxone fo r fever and neutropenia is effective and safe in pediatric patients with so lid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients). Med. Pe diatr. Oncol. 34:87-91, 2000. (C) 2000 Wiley-Liss. Inc.