Randomized trial of oral versus intravenous antibiotics in low-risk febrile neutropenic patients with lung cancer.
BACKGROUND
Neutropenic fever is one of the most serious adverse effects of cancer chemotherapy. Neutropenia may cause a life-threatening bacterial infection. Therefore, febrile neutropenic inpatients are empirically treated with intravenous broad-spectrum antibiotics. Recently, several studies have suggested the presence of low-risk groups among febrile neutropenic patients.


METHODS
A prospective randomized trial was conducted to compare treatment with oral ciprofloxacin (200 mg) and amoxicillin-clavulanate (375 mg) administered every 8 h against that with intravenous ceftazidime (1 g) administered every 12 h in low-risk febrile neutropenic patients with lung cancer. All patients received chemotherapy and antibiotic therapy while being hospitalized.


RESULTS
A total of 177 patients with lung cancer agreed to participate in this study prior to undergoing chemotherapy. Among them, a total of 36 neutropenic patients with 42 febrile episodes were enrolled in the study. Treatment was successful without the need for modification in 91% of the episodes in patients receiving the oral regimen and 79% of the episodes in patients receiving the intravenous regimen. No treatment-related deaths occurred. One patient developed nausea while receiving the oral regimen, so the oral regimen was changed to the intravenous regimen in this patient.


CONCLUSIONS
This prospective study suggested that treatment with oral antibiotics ciplofloxacin plus amoxicillin-clavulanate was effective for low-risk febrile neutropenic patients after chemotherapy.
Niho
Seiji
S
Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan. siniho@east.ncc.go.jp
Ohe
Yuichiro
Y
Goto
Koichi
K
Ohmatsu
Hironobu
H
Matsumoto
Taketoshi
T
Kubota
Kaoru
K
Kakinuma
Ryutaro
R
Nishiwaki
Yutaka
Y
D000284:Administration, Oral; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002442:Ceftazidime / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D011446:Prospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D002442:Ceftazidime