Christine Fuhrmann

Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge

Goals of workPatients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer (MASCC) score might benefit from ambulatory treatment. Optimal management remains to be clearly defined, and new oral antibiotics need to be evaluated in this setting.Materials and methodsCancer patients with febrile neutropenia and a favorable MASCC score were randomized between oral moxifloxacin and intravenous ceftriaxone. All were fit for early hospital discharge. The global success rate was related to the efficacy of monotherapy, as well as to the success of ambulatory monitoring.Main resultsThe trial was closed prematurely because of low accrual. Ninety-six patients were included (47 in the ceftriaxone arm and 49 in the moxifloxacin arm). A total of 65% were women, 30.2% had lymphoma, 34.4% had metastatic, and 35.4% had non-metastatic solid tumors. The success rates of home antibiotics were 73.9% and 79.2% for ceftriaxone and moxifloxacin, respectively. Seven patients were not discharged, and 14 required re-hospitalization. There were 17% of microbiologically documented infections that were, in most cases, susceptible to oral monotherapy.ConclusionsThese results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.

Prise en charge à domicile des neutropénies fébriles courtes après chimiothérapie : résultats et leçons d'une étude pilote menée sur deux ans dans un centre de lutte contre le cancer

Résumé:L’étude a pour but de tester la faisabilité d’une prise en charge précoce à domicile des aplasies fébriles sans facteurs de mauvais pronostic. Sur 517 épisodes de neutropénies fébriles enregistrés entre 07/99 et 06/01, seuls 52 cas ont bénéficié de cette prise en charge avec Céfépime 2g 2 fois par jour. Dans les autres cas, il existait des facteurs de mauvais pronostic ou des échecs organisationnels. Sur les 52 cas, 50 cas ont été des succès avec retour à domicile rapide, antibiothérapie efficace et absence de réhospitalisation. Dans les 2 autres cas, le départ a du être différé pour complications. Cette stratégie est donc tout à fait optimale sur une population correctement sélectionnée. Les nouveaux scores pronostics de la neutropénie fébrile et le développement croissant des soins à domicile devraient permettre d’élargir la population cible pour cette prise en charge ambulatoire.Abstract:The aim of this study is to determine the feasibility of early home care for febrile aplasia when there are no poor diagnostic factors. Of 517 episodes of febrile neutropenia recorded between July 1999 and June 2001, only 52 have benefited from early home care with Cefepime 2 g, twice a day. In the other cases, there were poor prognostic factors or organizational failures. Of the 52 cases, 50 had favorable outcomes after early hospital discharge and effective antibiotic therapy, with no need for readmission to hospital. For the remaining two cases, discharge was postponed because of complications. This is, therefore, clearly the optimal treatment strategy for a carefully selected patient population. New prognostic scoring for febrile neutropenia and the ongoing development of home care services should make it possible to expand the target population for this type of outpatient care.