Management of febrile neutropenia in low risk cancer patients
Authors: H Oppenheim BA, Anderson
Journal: Thorax (2000)

Background.Among patients with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral administration of empirical broad-spectrum antibiotics may be an acceptable alternative to intravenous treatment.Methods.We conducted a randomized, doubleblind, placebo-controlled study of patients (age 5-74 years) who had fever and neutropenia during chemotherapy for cancer.Neutropenia was expected to be present for no more than 10 days in these patients, and they had to have no other underlying conditions.Patients were assigned to receive either oral ciprofloxacin plus amoxycillin-clavulanate or intravenous ceftazidime.They were hospitalized until fever and neutropenia resolved.Results.A total of 116 episodes were included in each group (84 patients in the oral-therapy group and 79 patients in the intravenous-therapy group).The mean neutrophil counts at admission were 81 per cubic millimetre and 84 per cubic millilitre, respectively; the mean duration of neutropenia was 3.4 and 3.8 days, respectively.Treatment was successful without the need for modification in 71% of episodes in the oral-therapy group and 67% of episodes in the intravenous therapy group (difference between groups 3%, 95% confidence interval -8% to 15%; p=0.48).Treatment was considered to have failed because of the need for modifications in the regimen in 13% and 32% episodes, respectively (p<0.001) and because of the patients' inability to tolerate the regimen in 16% and 1% of episodes, respectively (p<0.001).There were no deaths.The incidence of intolerance of the oral antibiotics was 16% as compared with 8% for placebo (p=0.07).Conclusions. In hospitalized low-risk patients who have fever and neutropenia during cancer chemotherapy, empirical therapy with oral ciprofloxacin and amoxicillin-clavulanate is safe and effective.(N Engl J Med 1999; 341:305-11) Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy WV Kern, A Cometta, R de Bock, J Langenaeken, M Paesmans, H Gaya for the International Antimicrobial Therapy Cooperative Group of the European Organization for the Research and Treatment of CancerBackground.Intravenously administered antimicrobial agents have been the standard choice for the empirical management of fever in patients with cancer and granulocytopenia.If orally administered empirical therapy is as effective as intravenous therapy, it would offer advantages such as improved quality of life and lower cost.Methods.In a prospective, open-label, multicentre trial, we randomly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin (750 mg twice daily) plus amoxycillinclavulanate (625 mg three times daily) or standard daily doses of intravenous ceftriaxone plus amikacin.All patients were hospitalized until their fever resolved.The primary objective of the study was to determine whether there was equivalence between the regimens, defined as an absolute difference in on July 25, 2023 by guest.Protected by