title: Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children--a systematic review of prospective trials.
abstract: BACKGROUND
  There is no consensus on whether therapeutic intensity can be reduced safely in children with low-risk febrile neutropenia (FN). Our primary objective was to determine whether there is a difference in efficacy between outpatient and inpatient management of children with low-risk FN. Our secondary objective was to compare oral and parenteral antibiotic therapy in this population.
  
  
  METHODS
  We performed electronic searches of Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in low-risk FN. Percentages were used as the effect measure.
  
  
  RESULTS
  From 7,281 reviewed articles, 16 were included in the meta-analysis. Treatment failure, including antibiotic modification, was less likely to occur in the outpatient setting compared with the inpatient setting (15 % versus 28 %, P = 0.04) but was not significantly different between oral and parenteral antibiotic regimens (20 % versus 22 %, P = 0.68). Of the 953 episodes treated in the outpatient setting and 676 episodes treated with oral antibiotics, none were associated with infection-related mortality.
  
  
  CONCLUSIONS
  Based on the combination of results from all prospective studies to date, outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible.
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Manji
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.forename: L L
authors.initials: LL
authors.lastname: Dupuis
authors.forename: R
authors.initials: R
authors.lastname: Phillips
authors.forename: T
authors.initials: T
authors.lastname: Lehrnbecher
authors.forename: L
authors.initials: L
authors.lastname: Sung
mesh_terms: D000284:Administration, Oral; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents