Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients.
BACKGROUND
We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode.


METHODS
Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature > or =38.0 degrees C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access.


RESULTS
There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17-77) years, and 60% (n = 153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p < 0.002); Zubrod performance status > or =2 (p = 0.029); ANC <100/ml (p = 0.039), and age > or =70 years (p = 0.048).


CONCLUSIONS
Outpatient treatment of low-risk febrile neutropenic cancer patients utilizing standard treatment pathways is associated with minimal morbidity and mortality and should be considered an acceptable standard of care with appropriate infrastructure available to provide strict and careful follow-up while on treatment. Certain factors are associated with higher risk of hospitalization and should be further examined in eligible patients with low-risk febrile neutropenia.
Escalante
Carmen P
CP
Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 437, Houston, TX 77030, USA. cescalan@mdanderson.org
Weiser
Mary Ann
MA
Manzullo
Ellen
E
Benjamin
Robert
R
Rivera
Edgardo
E
Lam
Tony
T
Ho
Vi
V
Valdres
Rosalie
R
Lee
Eva Lu
EL
Badrina
Noemi
N
Fernandez
Sally
S
DeJesus
Yvette
Y
Rolston
Kenneth
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D002442:Ceftazidime / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D019091:Critical Pathways; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D002981:Clindamycin; D002939:Ciprofloxacin; D000667:Ampicillin; D002442:Ceftazidime