Management of the Febrile Child with Neutropenia

Author: Karl E. Miller
Date: Oct 1, 2000

Children who are neutropenic secondary to cancer chemotherapy are usually admitted to the hospital for treatment with broad-spectrum antibiotics when they develop a fever. Results of recent studies in adults have shown that many infections can be successfully treated in the outpatient setting. Retrospective study results have shown that children with cancer who present with a fever are at low risk for bacteremia if the following findings are present: temperature less than 39.1[degrees]C (102.4[degrees]F), monocyte count greater than 100 mm3 and a diagnosis of a solid tumor. Aquino and colleagues examined the efficacy of using ciprofloxacin in the outpatient management of selected pediatric patients with fever during an episode of neutropenia.

Patients were eligible for enrollment if they were one to 21 years of age, their malignancy was in remission, it had been seven or more days since their last chemotherapy course and they had an absolute phagocyte count of greater than 100 mm3. In addition, the parents had to be reliable. After appropriate laboratory tests, the children received a single dose of intravenous ceftazidime (50 mg per kg). If the child was clinically well after being observed from two to 23 hours, enrollment was offered. Treatment began with ciprofloxacin therapy (20 mg per kg per day in two divided doses). The children were maintained on the ciprofloxacin therapy until they were afebrile for 24 hours, had negative blood cultures and evidence of bone marrow recovery. If the children appeared toxic, had positive blood cultures or were febrile for five or more days, they were admitted for inpatient treatment.

Eighty-nine percent of the children were successfully treated as outpatients. Four percent of the children were admitted to a hospital because of positive blood cultures. Two of 45 children had to be admitted to the hospital because of noncompliance with the outpatient regimen. All those admitted had uncomplicated hospitalizations and recovered fully.

The authors conclude that outpatient antibiotic therapy has been shown to be safe and effective in certain children who have fever and are neutropenic. In this study, carefully selected, low-risk patients with febrile neutropenia were treated successfully without hospitalization. Outpatient treatment offers several advantages over inpatient management, including elimination of the need for a needle stick, reduced exposure to the risk of nosocomial infection and improved quality of life.

KARL E. MILLER, M.D.Aquino VM, et al. Feasibility of oral ciprofloxacin for the outpatientmanagement of febrile neutopenia in selected children with cancer.Cancer April 1, 2000;88:1710-4.

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