Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
Support Care Cancer. 2012 Jun;20(6):1135-45. doi: 10.1007/s00520-012-1425-8. Epub 2012 Mar 9.
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.
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.
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.
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.
对于低危发热性中性粒细胞减少症（FN）患儿，是否可以安全降低治疗强度尚无共识。我们的主要目的是确定低危 FN 患儿的门诊和住院管理在疗效上是否存在差异。我们的次要目的是比较该人群的口服和静脉用抗生素治疗。
我们对 Ovid Medline、EMBASE 和 Cochrane 对照试验中心注册库进行了电子检索，并将研究限定为低危 FN 的前瞻性儿科试验。使用百分比作为效应量。
从 7281 篇综述文章中，有 16 篇被纳入荟萃分析。与住院治疗相比，门诊治疗的治疗失败（包括抗生素调整）可能性更小（15%对 28%，P=0.04），但口服和静脉用抗生素方案之间无显著差异（20%对 22%，P=0.68）。在门诊治疗的 953 例和口服抗生素治疗的 676 例中，均未发生与感染相关的死亡。
根据迄今为止所有前瞻性研究的综合结果，门诊和口服抗生素治疗低危 FN 对儿童有效，在可行的情况下应纳入临床治疗。
