Early hospital discharge versus continued hospitalization in febrile pediatric cancer patients with prolonged neutropenia: A randomized, prospective study.
BACKGROUND
Hospitalization with single or multi-agent antibiotic therapy has been the standard of care for treatment of febrile neutropenia in cancer patients. We hypothesized that an empiric antibiotic regimen that is effective and that can be administered once-daily will allow for improved hospital utilization by early transition to outpatient care.


METHODS
Febrile pediatric cancer patients with anticipated prolonged neutropenia were randomized between a regimen of once-daily ceftriaxone plus amikacin (C + A) and imipenem monotherapy (control). Afebrile patients on C + A satisfying "Early Discharge Criteria" at 72 hr continued treatment as outpatients. We compared the outcome, adverse events, duration of hospitalization, and cost between both groups.


RESULTS
A prospective randomized controlled clinical trial was conducted on 129 febrile episodes in pediatric cancer patients with prolonged neutropenia. No adverse events were seen in 32 children (84% of study arm) treated on an outpatient basis. We found a statistically significant difference between the duration of hospitalization of the C + A group [median 5 days] and control [median 9 days](P < 0.001), per episode antibiotic cost (P < 0.001) and total episode cost (P < 0.001). There was no statistically significant difference in the response to treatment at 72 hr or after necessary antimicrobial modifications.


CONCLUSIONS
We conclude that pediatric febrile cancer patients initially considered at risk for sepsis due to prolonged neutropenia can be re-evaluated at 72 hr for outpatient therapy. The convenience, low incidence of adverse effects, and cost benefit of the once-daily regimen of C + A may be particularly useful to reduce the overall treatment costs and duration of hospitalization.
Ahmed
Nabil
N
Pediatric Branch, National Cancer Institute, Cairo University, Cairo, Egypt.
El-Mahallawy
Hadir A
HA
Ahmed
Ibrahim A
IA
Nassif
Shimaa
S
El-Beshlawy
Aamal
A
El-Haddad
Alaa
A
D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D000583:Amikacin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000191:economics; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D010351:Patient Discharge / Q000191:economics; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000583:Amikacin