Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy.
OBJECTIVE
To compare the use of intravenous vs. oral antibiotic therapy.


METHODS
All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo.


RESULTS
A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2%; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8%; the mean length of hospital stay was 7 days (range 3-10 days).


CONCLUSIONS
There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment.
Cagol
Angela Rech
AR
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Castro Junior
Cláudio Galvão de
CG
Martins
Maria Cristina
MC
Machado
Adão Leal
AL
Ribeiro
Renato Chagas
RC
Gregianin
Lauro J
LJ
Brunetto
Algemir Lunardi
AL
D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000188:drug therapy* / Q000401:mortality
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination