LUXEMBOURG-Outpatient oral antibiotic therapy can be as effective
and safe as outpatient parenteral therapy in the treatment of
febrile neutropenia, according to the latest trial results from
M.D. Anderson Cancer Center's Ambulatory and Supportive Care Oncology
Research Program (ASCORP).
ASCORP investigator Edward Rubenstein, MD, speaking at the 7th
International Symposium of the Multinational Association of Supportive
Care in Cancer (MASCC), stressed that the study population was
carefully selected. It consisted of clinically stable outpatients
who had good renal and hepatic function, had no comorbidities
requiring hospitalization, and lived within a 30-mile radius of
the cancer center.
"Cost minimization is important, but we cannot overlook the
fact that, along with the improvement in resource utilization,
there are potential disadvantages of outpatient therapy,"
Dr. Rubenstein cautioned. "We certainly don't want to develop
serious complications in the outpatient setting, so we need to
choose our patient population carefully and monitor them adequately."
In the last 7 years, he noted, some 300 to 400 patients with febrile
neutropenia have been treated on an outpatient basis in ASCORP,
with no infection-related deaths and no cases of septic shock.
The 179 participants in the new ASCORP trial were treated for
a minimum of 4 afebrile days, either with oral ciprofloxacin (Cipro)
plus amoxicillin/clavulanic acid (Augmentin) (88 patients), or
with an intravenous regimen of aztreonam (Azactam) plus clindamy-cin
Patients in whom fever persisted for 72 hours were considered
to be treatment failures and were crossed over to the other regimen.
Those with microbiologically documented infections were treated
until the infection resolved, cultures returned to negative, and
they were afebrile for 4 days.
The overall response rate to outpatient antibiotic therapy was
87% in the IV group and 90% in the oral group, Dr. Rubenstein
reported. "If we look at bacteremia, the response rate was
a little bit lower in the intravenous arm, 50% versus 77%,"