Early Versus Late Discontinuation of Empirical Antibiotics in Pediatric Oncology Patients With Fever and Neutropenia.

Abstract

The optimal timing for discontinuing antibiotics in pediatric oncology patients with unexplained fever and neutropenia remains uncertain. We analyzed 367 episodes of fever and neutropenia in hospitalized patients 0 to 19 years of age (2015 to 2022). Patients were grouped, based on antibiotic discontinuation timing: early (afebrile ≥24 h and negative cultures ≥48 h), late (ANC ≥500 cells/mm³), and intermediate (ANC <500 but afebrile ≥24 h). Among 298 culture-negative episodes, early (24.2%), late (36.2%), and intermediate (39.6%) groups showed no differences in new infections, intensive care admissions, or mortality. Outcomes were comparable for high- and low-risk patients. Early discontinuation appears safe and effective, even in high-risk patients.