Outpatient management of febrile episodes in neutropenic cancer patients

Febrile neutropenic patients have traditionally received hospital-based parenteral antibiotic therapy because of the risk of serious complications and associated mortality. Recently a low-risk subset among febrile neutropenic patients has been identified. Several alternatives to hospital-based therapy have been evaluated in such patients. These include early discharge to home antibiotic therapy after initial stabilization in the hospital, or treatment of the entire febrile episode with intravenous and/or oral antibiotics in an ambulatory setting. A multidisciplinary approach involving the physician and other health-care providers, the patients, and their families, ensures the success of this therapeutic modality. Careful patient selection, daily follow-up, close monitoring for the development of complications and/or adverse reactions, and informed consent along with detailed instructions to patients, minimize the risk of the development of serious complications. Outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients should now be considered an acceptable alternative to hospital-based therapy.