Oral cefixime is similar to continued intravenous antibiotics in the empirical treatment of febrile neutropenic children with cancer

Empiric oral antibiotic therapy for febrile neutropenic cancer patients has been suggested as a means to decrease hospitalization, but the safety of t his approach has not been adequately studied in children. We compared conti nued iv antibiotic therapy with switching treatment to orally administered cefixime in a group of selected febrile neutropenic children for whom blood cultures were sterile after 48 h of incubation. Two hundred episodes of fe brile neutropenia were studied (156 patients), and 100 episodes were random ized to receive each treatment. Failure to respond to therapy was defined b y documented or suspected bacterial infection, recurrent fever, or disconti nuation of assigned therapy for any reason before neutropenia resolved. Rat es of treatment failure were similar in the oral cefixime group (28%) and i n the iv antibiotic group (27%; P=1.0). Results support the safety of oral cefixime therapy for low-risk febrile neutropenic children, a therapeutic a pproach that would facilitate earlier outpatient management and decrease th e costs of treatment.