Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children--a systematic review of prospective trials

Support Care Cancer. 2012 Jun;20(6):1135-45. doi: 10.1007/s00520-012-1425-8. Epub 2012 Mar 9.


Background: There is no consensus on whether therapeutic intensity can be reduced safely in children with low-risk febrile neutropenia (FN). Our primary objective was to determine whether there is a difference in efficacy between outpatient and inpatient management of children with low-risk FN. Our secondary objective was to compare oral and parenteral antibiotic therapy in this population.

Methods: We performed electronic searches of Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in low-risk FN. Percentages were used as the effect measure.

Results: From 7,281 reviewed articles, 16 were included in the meta-analysis. Treatment failure, including antibiotic modification, was less likely to occur in the outpatient setting compared with the inpatient setting (15 % versus 28 %, P = 0.04) but was not significantly different between oral and parenteral antibiotic regimens (20 % versus 22 %, P = 0.68). Of the 953 episodes treated in the outpatient setting and 676 episodes treated with oral antibiotics, none were associated with infection-related mortality.

Conclusion: Based on the combination of results from all prospective studies to date, outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Administration, Oral
  • Ambulatory Care
  • Anti-Bacterial Agents / administration & dosage*
  • Child
  • Fever / drug therapy*
  • Fever / etiology
  • Humans
  • Neoplasms / drug therapy
  • Neutropenia / drug therapy*
  • Neutropenia / etiology
  • Risk Factors
  • Treatment Failure
  • Treatment Outcome


  • Anti-Bacterial Agents