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Published on: September 18, 2013

Febrile neutropenia in children with cancer

Stéphane Paulus1, Simon Dobson

  • 1British Columbia Children's Hospital, 4480 Oak Street, Ambulatory Care Building - Room K4-218, Vancouver, British Columbia, Canada. scpaullus@gmail.com

Advances in Experimental Medicine and Biology
|March 14, 2009
PubMed

Insights

Fever and neutropenia (FN) management in children requires standardized approaches. Effective empiric antimicrobial therapy includes monotherapy with piperacillin/tazobactam, cefipime, or meropenem, with outpatient care possible for low-risk patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Hematology-Oncology

Background:

  • Fever and neutropenia (FN) in children necessitates standardized definitions and management strategies.
  • Increasing incidence of Gram-positive infections, particularly Viridans group streptococci (VGS) in acute myeloid leukemia (AML) patients, contrasts with Gram-negative bacteria causing most FN-related mortality.

Purpose of the Study:

  • To address the need for consensus in defining fever and neutropenia (FN) in pediatric patients.
  • To optimize risk stratification, including outpatient management and early discharge protocols.
  • To guide the selection of appropriate empiric antimicrobial therapy for FN in children.

Main Methods:

  • Review of current guidelines and evidence for managing pediatric fever and neutropenia.
  • Analysis of antimicrobial efficacy and resistance patterns.
  • Evaluation of risk stratification tools for outpatient management and early discharge.

Main Results:

  • Piperacillin/tazobactam, cefipime, or meropenem are effective first-choice empiric antimicrobial monotherapies for FN.
  • No strong evidence supports adding aminoglycosides to initial empiric regimens.
  • Outpatient management with ceftriaxone or ciprofloxacin is feasible for selected low-risk patients.
  • Early chest CT (5-7 days) aids prompt diagnosis of pulmonary aspergillosis in high-risk patients.

Conclusions:

  • Standardized definitions and risk stratification are crucial for pediatric FN management.
  • Empiric antimicrobial monotherapy with specific agents is recommended.
  • Local microbiological data should guide antimicrobial selection.
  • Outpatient management and early diagnostic imaging can improve outcomes for specific patient subsets.

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