Febrile neutropenia in children

Fever is frequent in neutropenic patients and often related to infection. T wo major concepts, have contributed to the marked mortality decrease of tho se patients by the end of the 1960s: firstly, the duration and severity of neutropenia were the most important variables linked to infection and secon dly, prompt administration of broad-spectrum antimicrobials empirically, wa s life-saving. At the same time it was universally admitted that a careful daily examination of all portals of entry for micro-organisms was mandatory and that laboratory and imaging investigations were needed at regular inte rvals, keeping constantly in mind the individual type and stage of immunosu ppression. Through many studies, paediatricians contributed markedly in sta ndardisation of management of febrile neutropenic patients. Neutropenic pat ients are not equally prone to infections, partly due to the underlying can cer, chemotherapy and co-morbidity factors. Neutropenic children are not on ly vulnerable to bacteria, fungi and viruses commonly encountered in adults , but also to common viruses and bacteria. Very few studies included a vira l work-up. Epidemiological new trends are observed: Gram-positive bacteria and fungi are on the rise. Simplifying and shortening antibiotic regimens w ere made possible because new potent antibiotics were launched. Since the m id-1980s, many paediatric centres commonly discharge patients before comple te bone marrow recovery, provided that patients meet certain low-risk crite ria and do not exhibit any clinical or biological evidence of bacterial inf ection. However, a few prospective randomised studies have been conducted f or assessing the safety of early antibiotics discontinuation and safe early discharge. The choice of oral agents up to now was complicated by the relu ctance using fluoroquinolones in children. New challenges are numerous in t erms of diagnostic tools, detection of epidemiological trends and emerging pathogens, identification and control of nosocomial threats including drug resistance, assessment of the real impact of prophylaxis, evaluation of new agents, the need for more accurate risk scoring systems, outpatient manage ment and the necessity for an optimal use of resources. (C) 2000 Elsevier S cience B.V. and International Society of Chemotherapy. All rights reserved.