Oral vs. Intravenous Antibiotics in Treatment of Paediatric Febrile Neutropenia — ASN Events
  1. Schedule
  2. Supportive Care
  3. Posters - Supportive care
  4. Oral vs. Intravenous Antibiotics in Treatment of Paediatric Febrile Neutropenia

Oral vs. Intravenous Antibiotics in Treatment of Paediatric Febrile Neutropenia (#296)

Aditi Vedi 1 , Richard J Cohn 1 , Brent O'Carrigan 1
  1. Sydney Children's Hospital, Randwick, NSW, Australia

Purpose

To determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode.

Design

A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics to intravenous antibiotics in the treatment of febrile neutropenic episodes in low-risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RR) for dichotomous data and mean difference with standard deviation for continuous data.                                                                             

Results

Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% CI 0.78 to 1.32, p=0.91).

Table – Statistical Results

Outcome or Subgroup

Studies

Participants

Statistical Method

Effect Estimate

1.1 Treatment Failure

7

934

Risk Ratio (M-H, Random, 95% CI)

1.02 [0.78, 1.32]

1.2 Time to resolution of neutropenia

2

123

Mean Difference (IV, Random, 95% CI)

-1.14 [-2.14, -1.14]

Conclusions

In carefully selected low-risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics, as they lower the cost of treatment, as well as psychosocial burden on these children and their families. 

  1. Mullen CA, Petropoulos D, Roberts WM, et al. Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients. Cancer 1999;86:126-34.
  2. Cagol AR, De Castro Junior CG, Martins MC, et al. Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy. Jornal de Pediatria 2009;85:531-5.
  3. Gupta A, Swaroop C, Agarwala S, Pandey RM, Bakhshi S. Randomized controlled trial comparing oral amoxicillin-clavulanate and ofloxacin with intravenous ceftriaxone and amikacin as outpatient therapy in pediatric low-risk febrile neutropenia. J Pediatr Hematol Oncol 2009;31:635-41.
  4. Paganini HR, Sarkis CM, De Martino MG, et al. Oral administration of cefixime to lower risk febrile neutropenic children with cancer. Cancer 2000;88:2848-52.
  5. Paganini H, Gomez S, Ruvinsky S, et al. Outpatient, sequential, parenteral-oral antibiotic therapy for lower risk febrile neutropenia in children with malignant disease: a single-center, randomized, controlled trial in Argentina. Cancer 2003;97:1775-80.
  6. Petrilli AS, Dantas LS, Campos MC, Tanaka C, Ginani VC, Seber A. Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial. Med Pediatr Oncol 2000;34:87-91.
  7. Shenep JL, Flynn PM, Baker DK, et al. Oral cefixime is similar to continued intravenous antibiotics in the empirical treatment of febrile neutropenic children with cancer. Clin Infect Dis 2001;32:36-43.