Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial.
BACKGROUND
Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections.


METHODS
Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter.


RESULTS
Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived.


CONCLUSIONS
Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).
Petrilli
A S
AS
Pediatric Oncology Institute, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. iopepm@dialdata.com.br
Dantas
L S
LS
Campos
M C
MC
Tanaka
C
C
Ginani
V C
VC
Seber
A
A
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000008:administration & dosage*; D002511:Cephalosporins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage*; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors
D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002443:Ceftriaxone