Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial
Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial
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DOI：
10.1002/pbc.25012
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发表时间：
2014-08-01
影响因子：
3.2
通讯作者：
Ashley, David M.
中科院分区：
文献类型：
--
作者：
Orme, Lisa M.;Babl, Franz E.;Ashley, David M.
背景：发热性中性粒细胞减少症（FN）是儿科强化化疗方案常见的严重并发症。本试验的目的是比较低风险发热性中性粒细胞减少症（LRFN）儿童和青少年住院和门诊静脉抗生素管理的生活质量（QOL）。在这项随机非盲试验中，1 - 21岁接受低/中强度化疗的患者事先同意，在因FN符合低风险标准而急诊（艾德）时，随机接受门诊或住院治疗，静脉注射头孢吡肟50 mg/kg（12小时）。所有患者继续使用抗生素至少48小时，直至24小时无发热，并显示中性粒细胞绝对计数升高200/mm 3。通过每日问卷调查对生活质量的几个领域进行了检查。结果81例患者就诊于艾德，发热159次。涉及27例患者的37例FN表现被随机分配到住院（18例）和门诊（19例）管理。门诊组父母的综合QOL平均得分较高，门诊患者的三个特定父母变量（跟上家务/与伴侣共度的时间/与其他孩子共度的时间）得分较高。两组之间的父母对护理的信心/满意度没有差异。门诊组的患者总体得分更高，睡眠和食欲也更好。两组的平均发热时间相当，没有严重的不良事件归因于头孢吡肟或门诊治疗。结论LRFN的门诊头孢吡肟管理在几个QOL领域为父母和患者提供了显着的益处，并且似乎是可行和安全的。Pediatr Blood Cancer 2014; 61：1427-1433. (c)2014 Wiley Periodicals，Inc.
Background Febrile neutropenia (FN) is a frequent, serious complication of intensive pediatric chemotherapy regimens. The aim of this trial was to compare quality of life (QOL) between inpatient and outpatient intravenous antibiotic management of children and adolescents with low risk febrile neutropenia (LRFN). Procedure In this randomised non-blinded trial, patients between 1 and 21 years old, receiving low/moderate intensity chemotherapy were pre-consented and, on presentation to emergency (ED) with FN satisfying low risk criteria, randomised to either outpatient or inpatient care with intravenous cefepime 50mg/kg (12 hourly). All patients continued antibiotics for at least 48hours, until afebrile for 24hours and demonstrating a rising absolute neutrophil count 200/mm3. Several domains of QOL were examined by daily questionnaire. Results Eighty-one patients presented to ED with 159 episodes of fever. Thirty-seven FN presentations involving 27 patients were randomised to inpatient (18) and outpatient (19) management. Combined QOL mean scores for parents were higher for the outpatient group and scores for three specific parent variables (keeping up with household tasks/time spent with partner/time spent with other children) were higher among outpatients. There was no difference in parent confidence/satisfaction in care between groups. Patients scored better in the outpatient group overall and for sleep and appetite. The mean length of fever was equivalent between groups and there were no serious adverse events attributable to cefepime or outpatient care. Conclusion Outpatient cefepime management of LRFN provided significant benefit to parents and patients across several QOL domains and appeared both feasible and safe. Pediatr Blood Cancer 2014; 61:1427-1433. (c) 2014 Wiley Periodicals, Inc.