Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer.
BACKGROUND
Hospitalization and intravenous (IV) broad-spectrum antibiotics are the standard of care for all febrile neutropenic patients with cancer. Recent work suggests that a low-risk population exists who might benefit from an alternate approach.


METHODS
A prospective randomized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clindamycin 600 mg every 8 hours for the empiric outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer.


RESULTS
The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than that of the IV regimen (P < 0.0001), it was associated with significant renal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superior (P = 0.03).


CONCLUSIONS
This prospective study suggested that outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.
Rubenstein
E B
EB
Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Rolston
K
K
Benjamin
R S
RS
Loewy
J
J
Escalante
C
C
Manzullo
E
E
Hughes
P
P
Moreland
B
B
Fender
A
A
Kennedy
K
K
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001398:Aztreonam / Q000008:administration & dosage* / Q000191:economics; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage* / Q000191:economics; D002981:Clindamycin / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007275:Injections, Intravenous / Q000191:economics; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies
D002981:Clindamycin; D002939:Ciprofloxacin; D001398:Aztreonam