Duration of intravenous antibiotics for patients with neutropenic fever.
BACKGROUND
Standard therapy for febrile neutropenia after chemotherapy has consisted of intravenous antibiotic until resolution of both fever and neutropenia. We attempted to shorten the hospital stay by discontinuing intravenous antibiotics in blood culture negative patients who remained clinically stable and afebrile for 48 hours.


METHODS
Febrile neutropenic admissions of non-leukemic patients were reviewed. They were divided by three consecutive six month intervals into Group 1 (prior to initiation of the policy), Group 2 (after the policy was instituted), and Group 3 (to monitor the implementation of the policy after the initial six months).


RESULTS
There were 134 admissions for neutropenic fever. Median duration of intravenous antibiotic for Group 1 was 7 days (95% Confidence Interval 6-9). It was significantly decreased to 5 days (4-6) and 4 days (3-5) for Groups 2 and 3 respectively (p = 0.004 and p < 0.001). Median duration of hospital stay for Group 1 was 10 days (7-13). It was also significantly decreased to 7 (5-8) and 6 days (5-7) for Groups 2 and 3 respectively (p = 0.04 and p = 0.002).


CONCLUSIONS
Early discontinuation of intravenous antibiotics in patients with negative blood culture who remain afebrile and clinically stable for 48 hours results in shorter duration of hospital stay with potential for reduction in hospital costs.
Tomiak
A T
AT
Ottawa Regional Cancer Centre (Civic Division), Ontario, Canada.
Yau
J C
JC
Huan
S D
SD
Cripps
M C
MC
Goel
R
R
Perrault
D J
DJ
Bourcier
J D
JD
Prosser
I A
IA
Soltys
K M
KM
Evans
W K
WK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002442:Ceftazidime / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D009504:Neutrophils; D014031:Tobramycin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
D014640:Vancomycin; D002442:Ceftazidime; D014031:Tobramycin