Practical conclusion
The suspension of antibiotics after 48 to 72 hours of initiation is not associated with worse outcomes in the pediatric population with cancer who is admitted to a hospital due to febrile neutropenia and has a documented respiratory viral infection, negative bacteriological examinations, and good initial clinical evolution.[1]
Methodology
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Prospective, multicenter and randomized study, carried out in seven hospitals in Chile during the period from 2021 to 2023 with information from 939 pediatric oncology patients with a history of admission for febrile neutropenia.
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The patients’ risk of presenting invasive bacterial infections was recorded. In addition, clinical and laboratory parameters were analyzed, the search for bacteria (automated central and peripheral blood cultures and other cultures if clinically indicated) and viruses (polymerase chain reaction) was performed. [PCR múltiple] of nasopharyngeal exudates).
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Each patient was treated with antibiotic therapy from admission, according to available clinical management guidelines. Those with documented respiratory viral infection (n = 301) or negative bacteriology and good clinical evolution during the first 48 to 72 hours (n = 139) were randomized into 2 groups. Of that total, 70 continued with antibiotics and 69 discontinued them. In the comparison, different variables were taken into account, such as the percentage of episodes resolved without incident, days with fever, duration of hospitalization, need to re-administer antibiotics, presence of sepsis, requirement for admission to critical care units and mortality.
Main results
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The percentage of episodes of febrile neutropenia that resolved without incident rose to 94% in the group in which antibiotics were continued and reached 96% in the group in which they were discontinued (relative risk: 1.01; 95% confidence interval [IC 95%]: 0.93 to 1.09; absolute risk difference [DAR]: 0.01; 95% CI: 0.05 to 0.08).
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The median number of days of antibiotic therapy and days with fever were lower in the group that discontinued antibiotics (3 vs. 5 days; p p = 0.04), respectively). While the days of hospitalization (5 vs. 5), the days with an absolute neutrophil count 3 (4 vs. 4), and the percentage of patients requiring oxygen therapy (3% vs. 2%) were similar in both groups. .
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In both groups, no deaths, admissions to pediatric intensive care units, the presence of sepsis or the need for mechanical ventilation were reported. Only in 3 patients with high-risk febrile neutropenias did antibiotics need to be re-administered; This is due to the reappearance of fever in a period of between 5 and 7 days of follow-up. Each patient then had a favorable clinical course, with no detection of bacterial infection.
Clinical approach
“It was possible to validate a strategy to withdraw antimicrobial therapy in children with cancer and episodes of low- and high-risk febrile neutropenia. We recommend molecular detection of different respiratory viruses in the initial evaluation of all children with these characteristics who are admitted to a hospital “Such a strategy allows for more rational use of antimicrobial therapy and could have a future impact on resistance to these drugs,” the authors wrote.
Fountain
The article was published at the end of April 2024 in Clinical Microbiology and Infectionand its authors are a research group from the University of Chile and the infectious diseases committee of the National Children’s Program on Antineoplastic Drugs (PINDA) of said country.
Limitations
This was not a double-blind study. An evaluation of the costs and benefits associated with the routine use of polymerase chain reaction in this particular population was lacking.
Conflicts of interest
The authors have declared that they have no relevant financial conflicts of interest.
CREDIT
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Cite this article: Early withdrawal of antibiotics is not associated with a worse outcome in pediatric oncology patients with febrile neutropenia – Medscape – June 12, 2024.
