1503P - Oral versus intravenous antibiotics in low risk paediatric febrile netropenia: A meta-analysis of randomised controlled trials

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Complications of Treatment
Supportive Care
Cancer in Special Situations
Presenter Aditi Vedi
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors A. Vedi, R.J. Cohn
  • Children's Cancer Institute Of Australia, University of New South Wales Cancer Research Centre, 2052 - Sydney/AU

Abstract

Aim

Background: Sepsis is a major cause of morbidity and mortality in paediatric oncology patients, particularly during periods of neutropenia, which is a well-recognised complication of immunosuppressive therapy. Stratification of patients into low and high-risk categories has facilitated a new tailored approach to empiric therapy. The availability of oral antimicrobial drugs with broad-spectrum activity against common pathogens may provide an attractive alternative. Aim: To determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode.To determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode.

Methods

A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics to intravenous antibiotics in the treatment of febrile neutropenic episodes in low-risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RR) for dichotomous data and mean difference with standard deviation for continuous data.

Results

Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% CI 0.78 to 1.32, p = 0.91).

Conclusions

In carefully selected low-risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics, as they lower the cost of treatment, and psychosocial burden on these children and their families.

Disclosure

All authors have declared no conflicts of interest.