Ceftriaxone alone or in Combination with Teicoplanin in the Management of Febrile Episodes in Neutropenic Children and Adolescents with Cancer on an Outpatient Base.
OBJECTIVE
This study prospectively investigated the outpatient once daily therapy with ceftriaxone alone or if necessary in combination with teicoplanin, in the treatment of infections in children and adolescents with chemotherapy-induced neutropenia or aplastic anemia.


METHODS
42 patients 1-22 years of age suffering from solid tumors, hematological and oncological diseases, with clinical signs of infection, increased serum CRP (> 1 mg/dl) and/or fever above 38.5 degrees C and neutropenia (WBC count and/or ANC < 1 x 10(9)/l) were included in this outpatient based study. One important exclusion criterion was poor clinical condition with symptoms of septic shock.


METHODS
After bacterial, fungal and viral cultures had been obtained, single agent broad spectrum cephalosporin treatment was initiated with ceftriaxone applied once daily in a dose of 80 mg/kg body weight as short infusion over 30 min. Daily examinations included WBC, CRP, physical inspection and reassessment. In case of persistence or increase of fever and CRP, either outpatient management was carried on with teicoplanin added or patients were hospitalized and switched to combination antibiotic regimen.


RESULTS
There were 64 febrile episodes in 42 patients. Single agent once daily broad spectrum cephalosporin was adequate in 43/64 (67%) of infectious episodes in neutropenic patients. For persisting or increased fever or CRP elevation, 9 patients were treated with ceftriaxone and teicoplanin successfully. Thus hospitalized was avoided in 52/64 (81%) of infectious episodes.
Heinrich Heine Universität, Children's Hospital, Department of Hematology and Oncology, Düsseldorf.
S
S
Preis
H
H
Jürgens
C
C
Friedland
A A
AA
Oudekotte-David
L
L
Thomas
U
U
Göbel
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000188:drug therapy / Q000276:immunology*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001833:Body Temperature Regulation / Q000187:drug effects; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005335:Fever of Unknown Origin / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology*; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000276:immunology; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology; D017334:Teicoplanin / Q000008:administration & dosage*
D000970:Antineoplastic Agents; D017334:Teicoplanin; D002443:Ceftriaxone