title: Early hospital discharge with oral antimicrobial therapy in patients with hematologic malignancies and low-risk febrile neutropenia.
abstract: Although consensus exists relating criteria for the identification of low-risk patients with febrile neutropenia, no clear indication on how to manage these patients has been so far provided particularly in outpatients affected by hematologic malignancies. The feasibility and safety of early discharge was prospectively evaluated in 100 outpatients with hematologic malignancies and febrile neutropenia. A strategy considering the risk-index of the Multinational Association of Supportive Care in Cancer (MASCC) was applied. High-risk patients were entirely managed at hospital. Low-risk patients were early discharged if they were afebrile since 48 h and not on supportive therapy requiring hospitalization. Out of 90 low-risk episodes, in 69 instances (76.7%), patients were discharged after a median of 4 days and continued home therapy with oral cefixime (78%) or other antibiotics. Only five outpatients (7.2%) had fever recurrence. Twenty-one low-risk patients were not early discharged due to worsening conditions (three deaths), need of multiple daily dose therapy, or discharge refuse. No clinical characteristic was able to predict the eligibility for early discharge. The MASCC risk-index is a useful aid in the identification of high-risk febrile neutropenia needing whole in-hospital treatment. As for low-risk patients, hospitalization at least in the first days of fever is required. Cefixime could be included among the oral antibacterial drugs to be used in the outpatient treatment of adult patients with febrile neutropenia.
authors.affiliation: Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy. girmenia@bce.uniroma1.it
authors.forename: Corrado
authors.initials: C
authors.lastname: Girmenia
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.forename: Ida
authors.initials: I
authors.lastname: Carmosino
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.forename: Francesco
authors.initials: F
authors.lastname: Dragoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.forename: Sergio
authors.initials: S
authors.lastname: Mecarocci
authors.forename: Salvatore Giacomo
authors.initials: SG
authors.lastname: Morano
authors.forename: Caterina
authors.initials: C
authors.lastname: Stefanizzi
authors.forename: Giuliana
authors.initials: G
authors.lastname: Alimena
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications; D020682:Cefixime / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000150:complications; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D020682:Cefixime