Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients

作者：Craig A. Mullen, Demetrios Petropoulos, Walter Roberts, Michael Rytting, Theodore F. Zipf, Ka Wah Chan, Steven J. Culbert, Martha Danielson, Sima S. Jeha, John F. Kuttesch, Kenneth V. I. Rolston · 发表于：Cancer · 年份：1999 · DOI：10.1002/(sici)1097-0142(19990701)86:1<126::aid-cncr18>3.0.co;2-1 · 被引用次数：155 · 研究领域：Neutropenia and Cancer Infections、Sepsis Diagnosis and Treatment、Hematological disorders and diagnostics

BACKGROUND: Fever and neutropenia (F&N) is a common complication of cancer chemotherapy. It is conveniently managed by hospitalization and empiric administration of parenteral antibiotics. This study attempted to determine whether pediatric cancer patients with F&N identified as low risk for morbidity and mortality by clinical criteria at the time of presentation could be treated safely as outpatients. METHODS: Seventy-three episodes of F&N in 41 patients were studied prospectively over 2 years. Eligibility criteria included age > or =2 years, reliable caretakers, and residence within 1 hour of the hospital. Exclusion criteria included hemodynamic instability, dehydration, severe mucositis, pneumonia, leukemia/lymphoma induction therapy, bone marrow transplantation, or other serious comorbidity. Patients were evaluated, received a single dose of intravenous ceftazidime, and were observed for 3-16 hours. They were randomized to receive either oral ciprofloxacin or intravenous ceftazidime as outpatients. Patients were seen daily until they had been afebrile for at least 48 hours and had a rising absolute phagocyte count of >500 cells/microL. RESULTS: Sixty-three of 73 episodes (86%) were successfully managed on an outpatient basis. For 31 of 33 episodes in the ceftazidime arm, the patients remained outpatients, compared with 32 of 40 in the ciprofloxacin arm; this difference was not statistically significant. On average, patients remained febrile for 2.7 days and were treated f...