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(Drug information on ciprofloxacin) (Cipro) plus amoxicillin(Drug information on amoxicillin)/clavulanic acid (Augmentin) (88 patients), or with an intravenous regimen of aztreonam(Drug information on aztreonam) (Azactam) plus clindamy-cin (91 patients).
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%," he said.