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Evidence summaries

Oral Versus Intravenous Antibiotic Treatment for Febrile Neutropenia in Cancer Patients

Oral antibiotics are an acceptable alternative to intravenous antibiotics for treating febrile neutropenia in cancer patients at low risk for complications. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 23 studies (3142 episodes in 2372 patients) on the efficacy of oral antibiotics versus intravenous antibiotic therapy in febrile neutropenic cancer patients. Median mortality in the studies was 0 (range 0 to 8.8%).

The mortality rate was similar comparing oral to intravenous antibiotic treatment (RR 0.95, 95% CI 0.54 to 1.68, 9 trials, 1392 patients). Treatment failure rates were also similar (RR 0.96, 95% CI 0.86 to 1.06, all trials). This effect was stable in a wide range of patients. Quinolones alone or combined with another antibiotics were used with comparable results. Adverse reactions, mostly gastrointestinal were more common with oral antibiotics.

Oral treatment is an acceptable alternative to intravenous antibiotic treatment in febrile neutropenic cancer patients (excluding patients with acute leukaemia) who are haemodynamically stable, without organ failure, not having pneumonia, infection of a central line or a severe soft-tissue infection.

    References

    • Vidal L, Ben dor I, Paul M, Eliakim-Raz N, Pokroy E, Soares-Weiser K, Leibovici L. Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003992.

Primary/Secondary Keywords