Early discontinuation of empiric antibiotic therapy in children treated for cancer who develop febrile neutropenia: A prospective cohort study

Introduction

Febrile neutropenia (FN) is a life-threatening complication for children with cancer. Early administration of broad–spectrum antibiotics has significantly improved outcome. In many countries, children with culture negative FN remain hospitalized on intravenous antibiotic treatment until neutrophil count recovery. The aim of this study was to explore the safety of short course antibiotic regimens in children with culture negative FN.

Methods

A prospective cohort study with 1:1 matched historical controls was conducted in a single center. Children with cancer admitted with a low-risk episode of FN from 2017 until 2020 and met the inclusion criteria, were included in the study. The study was initiated after institutional adoption of an early antibiotic discontinuation protocol for low-risk FN. All children received empiric treatment with cefepime or piperacillin/tazobactam combined with an aminoglycoside. Antibiotics were discontinued after 48 h of defervescence, when blood cultures were negative regardless of neutrophil count.

Results

Thirty-six out of 456 FN episodes met inclusion criteria. There were no readmissions due to fever or infection during neutropenia. Median neutrophil count at discontinuation was 0.16 × 10⁹/L. Median length of hospitalization was 2 days, compared with 6 days until neutrophil recovery (p < 0.0001) and 7 days for the control group (p < 0.0001). There was significant reduction of hospital charges compared to controls.

Conclusion

This study provides evidence that early discontinuation of antibiotics in oncology patients with a low-risk episode of FN is safe, regardless of neutrophil count. Reduced exposure to antibiotics, shorter hospitalization and lower costs are beneficial secondary outcomes observed in this study.