Petrilli A S, Dantas L S, Campos M C, Tanaka C, Ginani V C, Seber A
Pediatric Oncology Institute, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Med Pediatr Oncol. 2000 Feb;34(2):87-91. doi: 10.1002/(sici)1096-911x(200002)34:2<87::aid-mpo2>3.0.co;2-f.
Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections.
Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter.
Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived.
Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).
感染是接受化疗儿童的主要并发症之一。对于低风险患者（实体瘤和Ⅰ/Ⅱ期淋巴瘤），单用环丙沙星或头孢曲松治疗是安全有效的。这些药物可在门诊使用，从而降低成本和医院感染风险。
将70例有发热和中性粒细胞减少发作的低风险患者（共116次发作）随机分为两组，门诊患者分别接受口服环丙沙星或静脉注射头孢曲松治疗。只有1例患者有中心静脉导管。
环丙沙星组和头孢曲松组中，发热和中性粒细胞减少发作分别被分类为不明原因发热（41%对32%）或临床确诊感染（56%对63%）。这些感染大多源于上呼吸道、皮肤或胃肠道。中性粒细胞减少的平均持续时间分别为5天和6天。发热持续1 - 9天（平均分别为2天和3天）。83%和75%的发作在未调整治疗的情况下获得成功。发作期间住院的患者比例分别为7%和4%。两组均未出现骨或关节副作用。所有患者均存活。
对于实体瘤和Ⅰ/Ⅱ期非霍奇金淋巴瘤的儿科患者（低风险患者），口服环丙沙星或静脉注射头孢曲松进行门诊治疗发热和中性粒细胞减少是有效且安全的。
