Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy

• Published in: Jornal de pediatria Vol. 85; no. 6; pp. 531 - 535
• Main Authors: Cagol, Angela Rech, Castro Junior, Cláudio Galvão de, Martins, Maria Cristina, Machado, Adão Leal, Ribeiro, Renato Chagas, Gregianin, Lauro J, Brunetto, Algemir Lunardi
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 01.11.2009
• Subjects: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination - therapeutic use; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Ciprofloxacin - therapeutic use; Epidemiologic Methods; Female; Humans; Injections, Intravenous; Length of Stay; Male; Neoplasms - drug therapy; Neutropenia - drug therapy; Neutropenia - mortality
• ISSN: 0021-7557; 1678-4782
• DOI: 10.2223/JPED.1956

To compare the use of intravenous vs. oral antibiotic therapy. All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo. A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2%; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8%; the mean length of hospital stay was 7 days (range 3-10 days). There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment.