Antibiotic treatment for febrile neutropenia : outpatient oral versus inpatient intravenous administration

Abstract

Overview of the topic: Febrile neutropenia (FN) is considered as a common complication of chemotherapy and hematological malignancies (Manji et al., 2012). FN is a life threatening emergency and characterized by pyrexia of unknown origin and insufficient absolute neutrophil count (de Naurois et al., 2010; Manji et al., 2012). Hospitalization and administration of intravenous antibiotics is standard local management and proves effective in reducing mortality (Manji et al., 2012; Grech, M., personal communication, January 25, 2017). However, a number of undesired outcomes associated with hospitalization and intravenous administration are reported (Manji et al., 2012). In this dissertation, the purpose is to evaluate whether outpatient management via orally administrated antibiotics is a safe and effective alternative. The research question: In clients with febrile neutropenia, are oral antibiotics on an outpatient basis, as effective as intravenous antibiotics on an inpatient basis, in reducing the risk of mortality? PICO elements: Population/Problem: Clients with febrile neutropenia. Intervention: Oral antibiotics on an outpatient basis. Comparison: Intravenous antibiotics on an inpatient basis. Outcome: Reduced risk of mortality. Method: The PICO elements of the question and the hierarchy of evidence where used to guide inclusion and exclusion criteria which are presented in Table 2.5. A list of alternate search terms was generated and word combinations developed using Boolean Operators. The University of Malta’s HyDi gateway, CINAHL Plus with Full text, Cochrane Central Register of Controlled trials, Cochrane Database of systemic reviews, PubMed and Medline Complete were used for the systematic search. The retrieved articles were critically appraised with the utilization of The Critical Appraisal Skills Programme (CASP). Results: Seven articles met all inclusion criteria. These include five meta-analyses and two randomized controlled trials (RCTs). After assessment of the results, these were compared. Results were similar across studies. Findings indicate that both interventions are equally effective. However, consideration of numerous factors hinders attempts for a conclusive answer. Conclusion: A definitive answer is so far inconclusive due to a lack of trials, uniform risk stratification methods and evidence to support implementation in routine practice. However, as evidenced, some FN patients may benefit from outpatient management via oral antibiotics. Implications and recommendations: Gaps in research need to be addressed in the future to provide definitive evidence. Local practitioners must be vigilant to new developments in this area and patient education for preventing complications should always be provided irrespective of treatment setting.