[Treatment with oral antibiotics of febrile neutropenia in onco-haematology. The experience of the EORTC antimicrobial group].
THE CONTEXT: Up until the nineties, the intravenous administration of a broad spectrum antibiotic was the classical treatment of any patient presenting with febrile neutropenia. Since then, in patients considered at low risk and with expected of neutropenia less than 7-10 days, oral antibiotherapy has become an attractive option. TWO LARGE STUDIES: A study by the antimicrobial group of the EORTC (European organisation for research and treatment of cancer) and a North American study have compared the efficacy of an oral combination of ciprofloxacine and amoxicillin/clavulanic acid with that of an intravenous antibiotherapy in low-risk patients presenting febrile neutropenia. In both studies, the success rate was the same in the group of patients treated with oral antibiotics and those treated with intravenous antibiotics. RESERVATIONS: These two studies were conducted in hospitalised patients. No conclusions can be drawn with regard to out-patient treatment. Out-patient management would only be possible after appropriate selection of patients at low risk.
Cometta
A
A
Div. des maladies infectieuses, CHUV, 1011 Lausanne, Suisse. alain.cometta@chyc.ch
Kern
W
W
D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002442:Ceftazidime / Q000008:administration & dosage / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D005060:Europe; D005334:Fever / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D007297:Inpatients; D015337:Multicenter Studies as Topic; D009369:Neoplasms / Q000150:complications* / Q000276:immunology; D009503:Neutropenia / Q000150:complications*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016896:Treatment Outcome; D014481:United States
D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D002442:Ceftazidime