Oral cefixime is similar to continued intravenous antibiotics in the empirical treatment of febrile neutropenic children with cancer.
Empiric oral antibiotic therapy for febrile neutropenic cancer patients has been suggested as a means to decrease hospitalization, but the safety of this approach has not been adequately studied in children. We compared continued iv antibiotic therapy with switching treatment to orally administered cefixime in a group of selected febrile neutropenic children for whom blood cultures were sterile after 48 h of incubation. Two hundred episodes of febrile neutropenia were studied (156 patients), and 100 episodes were randomized to receive each treatment. Failure to respond to therapy was defined by documented or suspected bacterial infection, recurrent fever, or discontinuation of assigned therapy for any reason before neutropenia resolved. Rates of treatment failure were similar in the oral cefixime group (28%) and in the iv antibiotic group (27%; P=1.0). Results support the safety of oral cefixime therapy for low-risk febrile neutropenic children, a therapeutic approach that would facilitate earlier outpatient management and decrease the costs of treatment.
Shenep
J L
JL
Department of Infectious Diseases, St. Jude Children's Research Hospital, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA. jerry.shenep@stjude.org
Flynn
P M
PM
Baker
D K
DK
Hetherington
S V
SV
Hudson
M M
MM
Hughes
W T
WT
Patrick
C C
CC
Roberson
P K
PK
Sandlund
J T
JT
Santana
V M
VM
Sixbey
J W
JW
Slobod
K S
KS
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D020682:Cefixime / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003257:Consumer Product Safety; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D020682:Cefixime