[Outpatient parenteral antibiotic therapy in pediatric oncology patients with fever in neutropenia: literature review and scoping review].

Abstract

Fever in neutropenia (FN) is a common complication in pediatric oncology patients receiving chemotherapy. These patients are usually treated as inpatients. Alternatively, under certain conditions, pediatric outpatient parenteral antibiotic therapy (pAPAT) may be an option.Literature search from PubMed and the Cochrane Library. Review of the included studies in a Summary of Findings table. Interpretation of the results by pediatric oncologists and infectious disease specialists.Twelve original studies involving 653 pAPAT courses were evaluated. pAPAT was used in stable patients in good general condition, with reliable adherence and accessibility (as outpatients), without a focus of infection and with negative blood cultures during the course of treatment. pAPAT was successfully completed in 75-95% of cases and was not inferior to inpatient treatment in comparative studies. There were no infection-associated deaths in the pAPAT group. The vast majority of patients and their families rated the pAPAT experience positively.The available studies are very heterogeneous in terms of definitions, risk stratification, selection of antibiotics, and the structural, organizational, and personnel processes involved in pAPAT. Taking these limitations into account, pAPAT after at least 24 hours of inpatient monitoring appears to be an effective and safe alternative to inpatient treatment for pediatric oncology patients with fever in neutropenia who display a low risk of severe complications.