Out-patient management of febrile neutropenia in indigent paediatric patients

Affordability of costly in-patient medical care and accessibility to the few cancer centres are serious problems faced by cancer patients in developing countries. Febrile neutropenia in particular is a major problem because delay in institution of antibiotic therapy can be rapidly fatal. We conducted a prospective non-randomised trial to evaluate the efficacy of administration of oral ofloxacin by caregivers to paediatric cancer patients with fever and neutropenia. Patients receiving chemotherapy who resided for away and were unable to reach the oncology ward within 12 hours of onset of fever or were unable to afford the expensive in-patient care were eligible for inclusion in the study. Requirements for enrollment included an absolute neutrophil count of < or = 0.5 x 10(9)/L, a temperature of > or = 38 degrees C, and ability to take oral medications. Caregivers were instructed to immediately administer oral ofloxacin on recognition of fever and to maintain constant contact with the oncology staff. Eighty-five of the 91 episodes were evaluable. These were most patients with solid tumours or non-Hodgkin's lymphoma (79%). Duration of neutropenia and fever was short and majority had pyrexia of undetermined origin (84%). Seventy-seven (91%) of the febrile episodes responded to ofloxacin with resolution of fever and neutropenia and hospitalisation was never required. Eight (9%) patients required hospitalisation. Most of them had prolonged neutropenia. They all responded to parenteral antibiotic therapy. No toxicity was observed and the cost of therapy was negligible. Out-patient therapy with oral ofloxacin may be an alternative to hospitalisation for those paediatric patients who are unable to afford or do not have access to in-patient care.