title: Ciprofloxacin and amoxicillin as continuation treatment of febrile neutropenia in pediatric cancer patients.
abstract: BACKGROUND
  The empiric administration of anti-microbial therapy significantly reduces the morbidity and mortality associated with febrile neutropenic episodes in oncology patients. Outpatient empiric antibiotic therapy can be safely administered to a subset of febrile neutropenic patients at low risk for clinical complications.
  
  
  METHODS
  Pediatric cancer patients presenting with febrile neutropenia after non-myeloablative chemotherapy and who met institutional criteria for early hospital discharge following a minimum of 48-hr inpatient empiric intravenous ceftazidime were eligible for the study. The feasibility and efficacy of an outpatient continuation therapy of oral ciprofloxacin (CPR) 25-30 mg/kg/day divided BID and amoxicillin (AMX) 30-50 mg/kg/day divided TID was assessed.
  
  
  RESULTS
  Thirty febrile neutropenic episodes in 26 patients were treated with outpatient oral CPR/AMX therapy. Oral CPR/AMX therapy was feasible in 28 (93%) and efficacious in 26 (87%) of treatment episodes. CPR/AMX was discontinued due to abdominal pain and diarrhea (n = 2), recurrent fever (n = 3), or gastrointestinal bleeding (n = 1). No patient developed new bacteremia or cardiopulmonary decompensation. Bone/joint pain or gastrointestinal symptoms occurred in 27% of treatment episodes. Duration of neutropenia, lower absolute neutrophil count (ANC) (< 100/mm(3)) at start of oral antibiotic therapy and active malignant disease were associated with failure of oral antibiotic therapy.
  
  
  CONCLUSIONS
  It is feasible to administer oral CPR/AMX as continuation antibiotic therapy for a selected subgroup of febrile neutropenic episodes defined after initial hospitalization and empiric antibiotic therapy. Prospectively randomized trials will be required to analyze adequately the efficacy of an oral CPR/AMX outpatient antibiotic regimen for treatment of febrile neutropenia in pediatric oncology patients.
authors.affiliation: Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington, USA. jpark2@chmc.org
authors.forename: Julie R
authors.initials: JR
authors.lastname: Park
authors.forename: James
authors.initials: J
authors.lastname: Coughlin
authors.forename: Douglas
authors.initials: D
authors.lastname: Hawkins
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.forename: Jane L
authors.initials: JL
authors.lastname: Burns
authors.forename: Thomas
authors.initials: T
authors.lastname: Pendergrass
mesh_terms: D000284:Administration, Oral; D000553:Ambulatory Care; D000658:Amoxicillin / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D002648:Child; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002939:Ciprofloxacin; D000658:Amoxicillin