Prospective evaluation of a policy of early discontinuation of antibiotics and discharge from hospital in children with cancer who develop fever
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Objective. To prospectively evaluate a set of clinical care schemata that would facilitate early discontinuation of antibiotics and hospital discharge in children with cancer admitted for management of infection. Methods. Based on recent published studies identifying children with fever and neutropenia who are at ‘‘low risk’’ for infection, and studies where antibiotics were discontinued quickly in such populations. We developed a set of four clinical schemata by which children with cancer would be managed at our institution. The schemata were prospectively evaluated over a period of 15 months. Results. The schemata were evaluated in 103 consecutive admissions in 69 children with cancer, admitted for treatment of presumed infection. In 61% of cases, children could be discharged home within 5 days of admission; only 9% was re-admitted within 7 days of discharge. In 77% of cases, children could be sent home on no antibiotics; in the remaining 23%, antibiotics could be narrowed in spectrum, and the majority sent home on an oral agent. Median length of stay for the entire cohort of patients was 5 days. In children receiving prophylactic G-CSF, the use of this agent did not impact on the length of stay, the need for subsequent re-admission, or the requirement for antibiotics at time of discharge. Conclusions. Early discontinuation of antibiotics and discharge from hospital is safe, provided that the child is clinically well and afebrile. Children with a clinical or microbiologic focus can have their spectrum of coverage narrowed, and can be safely discharged on oral agents. J Oncol Pharm Practice (2001) 6, 131-137.
