Emperical Oral Antibiotic Therapy for Children with Low Risk Febrile Neutropenia during Cancer Chemotherapy

Introduction: In patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods: We conducted a prospective hospital based study to the patients who had fever and neutropenia during caner chemotherapy. Only low risk patients i.e. neutropenia of less than seven days, ANC >250/cmm, without any signs of shock were included in the study. All the patients were hospitalized and given oral antibiotics Ofloxacin and Amoxy-Clav and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results: A total of 54 cases were enrolled in the study. Out of 54 patients two patients were lost, 8 needed IV antibiotics for different reasons and 44 patients (81%) improved well with oral antibiotics only. Conclusion: In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics. Key words: Febrile Neutropenia, Cancer Chemotherapy, ANC. doi:10.3126/jnps.v29i1.1596 J. Nepal Paediatr. Soc. Vol.29(1) p.22-25

Download Full-text

Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study

British Journal of Cancer ◽

10.1038/sj.bjc.6600993 ◽

2003 ◽

Vol 89 (1) ◽

pp. 43-49 ◽

Cited By ~ 95

Author(s):

H E Innes ◽

D B Smith ◽

S M O'Reilly ◽

P I Clark ◽

V Kelly ◽

...

Keyword(s):

Febrile Neutropenia ◽

Hospital Discharge ◽

Low Risk ◽

Oral Antibiotics ◽

Single Centre ◽

Early Hospital Discharge ◽

Patients With Cancer ◽

Intravenous Antibiotics ◽

Single Centre Study ◽

Randomised Controlled

Download Full-text

A randomized prospective open labeled study of oral amoxicillin-clavulanate with intravenous ceftriaxone and amikacin in low risk febrile neutropenia

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.18551 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 18551-18551

Author(s):

J. F. Dominic ◽

L. Kumar ◽

V. Kochupillai ◽

V. Raina ◽

A. Sharma ◽

...

Keyword(s):

Febrile Neutropenia ◽

Confidence Interval ◽

Response To Therapy ◽

Low Risk ◽

Comparable Efficacy ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Once Daily ◽

Oral Amoxicillin ◽

Amoxicillin Clavulanate

18551 Background: Empiric oral antibiotic administration is a treatment option in low risk febrile neutropenia. Methods: Low risk febrile neutropenia patients (expected neutropenic duration <7 days with no comorbid features) between 15 and 75 years of age were randomized to receive either oral amoxicillin-clavulanate 625 mg twice daily and levofloxacin 500 mg once daily or intravenous (i.v.) ceftriaxone 2 g and amikacin 15 mg/kg once daily. Most patients were treated on out patient basis. The primary end point was response to therapy- defervescence of fever within 72 hours with improvement in any clinical manifestation of infection and no recurrence of fever for 48 hours without use of antipyretics. Use of growth factors was not permitted except in treatment failure. The study was cleared by the institute ethics committee. Results: Sixty four episodes in 53 patients were evaluable, 33 in the i.v. group and 31 in the oral antibiotics group. The underlying diagnosis was bone and soft tissue sarcomas in 32 episodes, hematological cancers in 22 and other solid cancers in 10. The groups were equally matched for age (median 25 years in the i.v. arm and 19 years in the oral arm), gender, type of cancer, baseline absolute neutrophil count (median 200/μL in both arms) and duration of neutropenia (5 days and 4 days in the i.v. and oral groups respectively). A focus of infection was identified clinically in 15% of episodes and microbiologically in 11% of episodes; 57% of which were gram positive organisms and the rest gram negative. Seventy two percent (95% confidence interval 58% to 88%) in the i.v. arm and 77% (95% confidence interval 63% to 92%) in the oral arm responded to therapy. The only serious toxicity was one episode of convulsions in the i.v. group. All treatment failures received second line i.v. antibiotics. There was no mortality in either group. Comparing the two groups for equivalence (assuming a 25% difference between the two arms as unequal) the two groups were found to be equivalent with a power of 59% (p = 0.03). Conclusion: Oral antibiotics have comparable efficacy as intravenous antibiotics in the management of low risk febrile neutropenia. No significant financial relationships to disclose.

Download Full-text

Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.8222 ◽

2008 ◽

Vol 26 (4) ◽

pp. 606-611 ◽

Cited By ~ 105

Author(s):

Linda S. Elting ◽

Charles Lu ◽

Carmelita P. Escalante ◽

Sharon H. Giordano ◽

Jonathan C. Trent ◽

...

Keyword(s):

Febrile Neutropenia ◽

Statistical Tests ◽

Signs And Symptoms ◽

Low Risk ◽

Outpatient Management ◽

Single Episode ◽

Risk Patients ◽

Inpatient Management ◽

The Mean ◽

Mean Cost

Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

Download Full-text

Cost-effectiveness of home-based care of febrile neutropenia in children with cancer

10.22541/au.163251882.21756689/v1 ◽

2021 ◽

Author(s):

Michelle Tew ◽

Richard De Abreu Lourenco ◽

Joshua Gordon ◽

Karin Thursky ◽

Monica Slavin ◽

...

Keyword(s):

Cost Effectiveness ◽

Febrile Neutropenia ◽

Low Risk ◽

Hospital Treatment ◽

Decision Analytic Model ◽

Children With Cancer ◽

Patient Level ◽

Home Based ◽

Intravenous Antibiotics ◽

Home Based Care

INTRODUCTION Home-based treatment of low-risk febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing a low-risk FN program, incorporating home-based intravenous antibiotics, in a tertiary pediatric hospital. METHODS A decision analytic model was constructed to compare costs and outcomes of the low-risk FN program, with usual in-hospital treatment with intravenous antibiotics. The program included a clinical decision rule to identify patients at low-risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality-of-life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data. Patient-level costs were extracted from hospital records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS The mean healthcare cost of home-based FN treatment in low-risk patients was A$7,765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 (95% CI,12,496-12,767)). Overall, the low-risk FN program was the dominant strategy, being more effective (0.0011 QALY (95% CI,0.0011-0.0012)) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care program. CONCLUSION Compared to in-hospital FN care, the low-risk FN program is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the program.

Download Full-text

Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis

BMJ Case Reports ◽

10.1136/bcr-2020-237679 ◽

2021 ◽

Vol 14 (6) ◽

pp. e237679

Author(s):

Gavin Connolly ◽

Mita Kale ◽

Andrew Ustianowski

Keyword(s):

Prosthetic Valve ◽

Salmonella Enteritidis ◽

Prosthetic Valve Endocarditis ◽

Good Health ◽

Prosthetic Material ◽

Oral Antibiotic ◽

Rare Occurrence ◽

Combined Surgery ◽

Oral Antibiotic Therapy ◽

Intravenous Antibiotics

Infective endocarditis is associated with morbidity and mortality even when appropriately treated. It can be more complicated to treat when prosthetic material is present, often necessitating surgical revision as well as antimicrobial therapy. Endocarditis caused by gram-negative bacilli is a rare occurrence, with some literature and expert opinion suggesting superior outcomes with combined surgery and antibiotics when a prosthetic valve is involved. In cases where the prosthetic valve is well-functioning and undamaged, or cardiothoracic surgery represents a significant operative risk, it can be unclear how best to proceed. This report documents a case of Salmonella enterica subspecies enterica serovar enteritidis endocarditis of a mechanical mitral valve. The patient was managed with 6 weeks of intravenous antibiotics followed by suppressive oral antibiotic therapy. They remain in good health at 24 months.

Download Full-text

Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases

10.21203/rs.2.18846/v2 ◽

2020 ◽

Author(s):

Xiaohua Wang(Former Corresponding Author) ◽

Li Fang ◽

Yueqi Chen ◽

Shulin Wang ◽

Huan Ma ◽

...

Keyword(s):

Recurrence Rate ◽

Antibiotic Treatment ◽

Bone Infection ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Treatment Regimens ◽

Intravenous Antibiotics ◽

Abnormal Rate ◽

Oral Group ◽

Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

Download Full-text