title: Successful introduction and audit of a step-down oral antibiotic strategy for low risk paediatric febrile neutropaenia in a UK, multicentre, shared care setting.
abstract: OBJECTIVE
  Patients with febrile neutropaenia (FN) can be stratified according to their risk of significant complications, allowing reduced intensity therapy for low risk (LR) episodes. Serious events are very rare in low risk episodes making randomised trials difficult. Introduction of new evidence-based guidelines followed by re-auditing of the outcome is an alternative strategy.
  
  
  METHODS
  New guidelines for the management of LR FN were implemented in 4 specialist paediatric oncology centres (POCs) and in their associated shared care units (POSCUs). All patients commenced empirical intravenous antibiotic therapy and after 48h those with blood culture negative episodes designated LR were eligible for discharge on oral co-amoxiclav. Prospective data collection on FN episodes in all treatment centres was undertaken over a 1-year period.
  
  
  RESULTS
  Seven hundred and sixty two eligible episodes of FN were recorded in 368 patients; 213 episodes were initiated in POCs and 549 episodes were initiated in POSCUs. In 40% of episodes no clinical or microbiological focus of infection was found. At 48h, 212 (27%) episodes were classified as LR and 143 of these (19%) were managed on the LR protocol. There was a low hospital readmission rate (8/143 episodes; 5.6%), no intensive care admissions and no deaths in LR episodes. Almost all LR episodes (209/212) occurred in the shared care setting.
  
  
  CONCLUSIONS
  Rapid step-down to oral antibiotics was a feasible and safe management strategy for LR FN in the shared care setting in England.
authors.affiliation: Infectious Diseases and Microbiology Unit, Institute of Child Health, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Dommett
authors.forename: J
authors.initials: J
authors.lastname: Geary
authors.forename: S
authors.initials: S
authors.lastname: Freeman
authors.forename: J
authors.initials: J
authors.lastname: Hartley
authors.forename: M
authors.initials: M
authors.lastname: Sharland
authors.forename: A
authors.initials: A
authors.lastname: Davidson
authors.forename: R
authors.initials: R
authors.lastname: Tulloh
authors.forename: M
authors.initials: M
authors.lastname: Taj
authors.forename: S
authors.initials: S
authors.lastname: Stoneham
authors.forename: J C
authors.initials: JC
authors.lastname: Chisholm
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D007239:Infections / Q000188:drug therapy*; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D009503:Neutropenia / Q000209:etiology*; D036102:Peripheral Blood Stem Cell Transplantation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents