title: Systematic review of reduced therapy regimens for children with low risk febrile neutropenia.
abstract: Reduced intensity therapy for children with low-risk febrile neutropenia may provide benefits to both patients and the health service. We have explored the safety of these regimens and the effect of timing of discharge.
  
  
  
  Multiple electronic databases, conference abstracts and reference lists were searched. Randomised controlled trials (RCT) and prospective observational cohorts examining the location of therapy and/or the route of administration of antibiotics in people younger than 18 years who developed low-risk febrile neutropenia following treatment for cancer were included. Meta-analysis using a random effects model was conducted. I (2) assessed statistical heterogeneity not due to chance.
  
  
  
  PROSPERO (CRD42014005817).
  
  
  
  Thirty-seven studies involving 3205 episodes of febrile neutropenia were included; 13 RCTs and 24 prospective observational cohorts. Four safety events (two deaths, two intensive care admissions) occurred. In the RCTs, the odds ratio for treatment failure (persistence, worsening or recurrence of fever/infecting organisms, antibiotic modification, new infections, re-admission, admission to critical care or death) with outpatient treatment was 0.98 (95% confidence interval (95%CI) 0.44-2.19, I (2) = 0 %) and with oral treatment was 1.05 (95%CI 0.74-1.48, I (2) = 0 %). The estimated risk of failure using outpatient therapy from all prospective data pooled was 11.2 % (95%CI 9.7-12.8 %, I (2) = 77.2 %) and using oral antibiotics was 10.5 % (95%CI 8.9-12.3 %, I (2) = 78.3 %). The risk of failure was higher when reduced intensity therapies were used immediately after assessment, with lower rates when these were introduced after 48 hours.
  
  
  
  Reduced intensity therapy for specified groups is safe with low rates of treatment failure. Services should consider how these can be acceptably implemented.
authors.affiliation: Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK. jem539@york.ac.uk.|Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK. jem539@york.ac.uk.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Morgan
authors.affiliation: Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Jemma
authors.initials: J
authors.lastname: Cleminson
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Atkin
authors.affiliation: Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Stewart
authors.affiliation: Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.|Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Phillips
mesh_terms: D002648:Child; D064147:Febrile Neutropenia / Q000628:therapy*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care
keywords: Febrile neutropenia; Oral antibiotics; Outpatient; Paediatric; Systematic review