Cessation of antibiotics regardless of ANC is safe in children with febrile neutropenia. A preliminary prospective trial.
OBJECTIVE
This study was designed to evaluate the safety and efficacy of stopping antibiotic treatment regardless of absolute neutrophil count (ANC) or signs of impending neutrophil recovery in children with febrile neutropenia (FN) and no identifiable infectious source.


METHODS
Thirty-two consecutive cases of FN without identifiable source were prospectively evaluated. Patients were examined, cultured, and initially treated with ceftazidime +/- vancomycin. Antibiotics were discontinued and patients discharged regardless of ANC (WBC/microliter x [% segs + bands]) once all the following criteria were met: afebrile > or = 24 h; cultures negative at 48 h; thermometer and telephone available at home. Prompt notification of fever (T > 38.3 degrees C) and readmission were required.


RESULTS
Median ANC was 60/microliters on admission and 160/microliters at discharge. Median length of treatment was 3 days. Four patients were readmitted for FN, and two patients were readmitted afebrile for cultures which became positive after discharge. None of the 32 cases suffered apparent complications from early discharge.


CONCLUSIONS
Results of this preliminary trial suggest that cessation of antibiotics regardless of ANC is safe in cases of FN without identifiable source, provided that marrow is not infiltrated and that recurrent fever receives prompt antibiotic retreatment.
Cohen
K J
KJ
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA.
Leamer
K
K
Odom
L
L
Greffe
B
B
Stork
L
L
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D005334:Fever / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D009503:Neutropenia / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D009504:Neutrophils; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents