ABSTRACT
OBJETIVO: Comparar o uso de antibioticoterapia endovenosa versus oral. MÉTODOS: Foram selecionadas todas as crianças e adolescentes neutropênicos com idade inferior a 18 anos classificados como baixo risco para complicações e recebendo quimioterapia. O estudo ocorreu entre 2002 e 2005 na Unidade de Oncologia Pediátrica, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS). Os pacientes, divididos em grupo A e grupo B, eram randomizados para receber terapia oral ou endovenosa. O tratamento utilizado para o grupo A foi ciprofloxacina e amoxicilina/clavulanato via oral e placebo endovenoso e, para o grupo B, cefepime e placebo oral. RESULTADOS: Foram selecionados 91 episódios consecutivos de neutropenia febril em 58 crianças. Para os pacientes do grupo A, a taxa de falência foi de 51,2 por cento e a média de tempo de hospitalização foi de 8 dias (variação de 2-10). Para os pacientes tratados com antibioticoterapia endovenosa, a taxa de falência foi de 45,8 por cento e a média de tempo de hospitalização foi de 7 dias (variação de 3-10). CONCLUSÃO: Neste estudo não houve diferenças entre a antibioticoterapia oral versus a terapia endovenosa. Estudos randomizados com maior número de pacientes são necessários antes de padronizar a terapêutica oral como tratamento para esta população de pacientes.
OBJECTIVE: To compare the use of intravenous vs. oral antibiotic therapy. METHODS: All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo. RESULTS: A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2 percent; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8 percent; the mean length of hospital stay was 7 days (range 3-10 days). CONCLUSION: There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Neoplasms/drug therapy , Neutropenia/drug therapy , Administration, Oral , Epidemiologic Methods , Injections, Intravenous , Length of Stay , Neutropenia/mortalityABSTRACT
The combination of neutropenia and fever, with or without documented infection, is a commun complication in cancer patients receiving chemotherapy. The prompt institution of empirical broad-spectrum antibiotic therapy for febrile neutropenic patients has been shown to reduce the rate of early death and morbidity in cancer populations undergoing chemotherapy. Three different regimens for considerations as initial empiric therapy are presented. Alternatives such as outpatient regimens to low risk patients and monotherapy are discussed. If confirmed prospectively, the results presented here may enable clinicians to identify low risk groups and treat neutropenia and fever with good results and better economic and psychological cost.