Outpatient treatment of febrile episodes in low‐risk neutropenic patients with cancer

Background. Hospitalization and intravenous (IV) broad‐spectrum antibiotics are the standard of care for all febrile neutropenic patients with cancer. Recent work suggests that a low‐risk population exists who might benefit from an alternate approach. Methods. A prospective randomized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clindamycin 600 mg every 8 hours for the empiric outpatient treatment of febrile episodes in low‐risk neutropenic patients with cancer. Results. The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than that of the IV regimen (P < 0.0001), it was associated with significant renal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superior (P = 0.03). Conclusions. This prospective study suggested that outpatient antibiotic therapy for febrile episodes in low‐risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.