Leverger Guy
Service d'onco-hématologie pédiatrique, Hôpital Trousseau, Paris.
Presse Med. 2004 Mar 13;33(5):330-7. doi: 10.1016/s0755-4982(04)98579-x.
Fever in a neutropenic patient requires the rapid initiation of a broad spectrum antibiotic and continued until correction of the neutropenia. Several studies have been conducted recently in order to define the populations of children in whom the antibiotherapy could be suspended early without risk of relapse of fever and/or severe infection. Moreover, the high costs of hospitalisation and the limited number of beds in the departments of Paediatric Oncology Haematology have led to studies on the feasibility of an antibiotherapy at home. THE EARLY SUSPENSION OF THE ANTIBIOTHERAPY: The criteria retained in several studies for the early suspension of the antibiotherapy have been: apyrexia for at least 24 hours, a satisfactory clinical status, the absence of positive haemocultures and haematological signs showing the end of aplasia in patients in remission of their disease. Studies have confirmed the possibility of early suspension of intravenous antibiotics in low-risk patients, without fever and without microbiological signs. THE PLACE OF ORAL ANTIBIOTICS: In several comparative studies, the success rate with intravenous antibiotics and oral antibiotics was comparable. The rate of failures was greater in patients with severe initial neutropenia. OUTPATIENT ANTIBIOTICS: In children, 2 types of studies have been conducted. The first studied the feasibility of an antibiotherapy at home following antibiotherapy in the hospital in order to reduce the costs and duration of hospitalisation. The others proposed an antibiotherapy at home from the start, either with the intravenous or the oral route. Following all these studies, it appeared that, in certain low-risk neutropenic children with fever, not only the antibiotics could be suspended before the complete correction of the neutropenia, but also a large spectrum oral antibiotherapy could replace the intravenous antibiotherapy and outpatient treatment would therefore be feasible.
中性粒细胞减少患者发热时，需要迅速开始使用广谱抗生素，并持续用药直至中性粒细胞减少得到纠正。最近进行了几项研究，以确定哪些儿童群体可以早期停用抗生素而无发热和/或严重感染复发的风险。此外，住院费用高昂以及儿科肿瘤血液科床位有限，促使人们对在家进行抗生素治疗的可行性展开研究。
多项研究中用于早期停用抗生素治疗的标准包括：至少24小时无发热、临床状况良好、血培养阴性以及疾病缓解患者的血液学指标显示再生障碍结束。研究证实，低风险、无发热且无微生物学指标的患者有可能早期停用静脉抗生素。
在几项对比研究中，静脉抗生素和口服抗生素的成功率相当。初始中性粒细胞减少严重的患者失败率更高。
针对儿童进行了两类研究。第一类研究了在医院进行抗生素治疗后在家中进行抗生素治疗以降低住院成本和缩短住院时间的可行性。另一类则从一开始就建议在家中进行抗生素治疗，采用静脉或口服途径。经过所有这些研究发现，在某些发热的低风险中性粒细胞减少儿童中，不仅可以在中性粒细胞减少完全纠正之前停用抗生素，而且广谱口服抗生素治疗可以替代静脉抗生素治疗，因此门诊治疗是可行的。
