Background To enable outpatient department (OPD) management of febrile neutropenia (FN), we used once-a-day (OD) ceftriaxone–amikacin (CFT-AMK) as empiric antibiotic therapy. Our experience over 16-year period is presented.

Methods This was a retrospective study conducted from January2002 to December2017. Inclusion criteria were <18 years of age, undergoing cancer chemotherapy, and having FN. Exclusion criteria were FN after palliative chemotherapy, bone marrow transplantation, or at diagnosis of malignancy. Empiric CFT-AMK was used in all, except those having respiratory distress, hypotension, altered sensorium, paralytic ileus, or clinical evidence of peritonitis. Admission criteria were age <1 year, acute myeloid leukemia (AML) chemotherapy, poor performance status, need for blood transfusions, convenience, insurance, or persistent fever >48 to 72 hours after CFT-AMK. Outcomes analyzed were response (defervescence within 48–72 hours), OPD management, antibiotic upgrade, and mortality. AML diagnosis, >7 days to absolute neutrophil count >0.5 × 109/L, poor performance status, and malignancy not in remission were considered high-risk FN criteria.

Results CFT-AMK was given in 877/952 (92.2%) FN episodes. Seventy-six percent had hematolymphoid malignancies. Response, antibiotic upgrade, and mortality were seen in 85.7 and 65.5% (p < 0.0001), 15 and 45.5% (p < 0.0001), and 0 and 2% (p = 0.003) of low- and high-risk patients, respectively. Treatment was started in OPD in 52%, of which 21.6% required subsequent admission. Of those initially admitted, early discharge (hospital stay < 5 days) was possible in 24.6%. Forty-one percent episodes were managed entirely on OPD. Overall, 80% of low-risk and 42% of high-risk episodes received treatment wholly or partially on OPD.

Conclusion Our results show empiric OD CFT-AMK allows OPD management for most of the low-risk and a proportion of high-risk FN following chemotherapy in children, without compromising clinical outcomes.

S.K. designed the study; helped in data collection and analysis, and manuscript preparation. A.M. designed the study; helped in data analysis and critical review of manuscript. A.D. and S.P. helped in data collection and critical review of manuscript. C.D. helped in data analysis and manuscript preparation and review.

Institutional ethics committee approval: DMHRC Code—IHR_2021_Jan_SK_391; Dated: February 3, 2021. The study was approved by the institutional ethics committee.

None.

Article published online:
02 September 2022

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