- The goal of this study was to assess efficacy of the oral ciprofloxacin
as a way to treat fever and neutropenia episodes for those undergoing
chemotherapy with low risk for serious bacterial infection.
- The study cites prior studies for carefully selecting a lower risk
group and showing that they can be safely, and efficaciously be treated
as outpatient with oral antibiotic.
- The study design did not provide for double-blinding, which could
introduce bias in both parents and clinicians.
- The study also did not provide power of the study.
- There was one design flaw where patients were excluded from the study
after being randomized if they had developed bacteremia.
- Other studies confirm the findings in this study; however, inclusion
criteria and the population studied were slightly different. For example,
one study by Petrilli excluded those children with leukemia as their
- The study also uses ceftriaxone IV as the standard IV therapy for
comparison, which differs from our institution's standard for treatment
of fever and neutropenia, which is Zosyn and gentamicin. This may affect
the outcome if the study were to be done at our institution since microorganism
resistance pattern maybe different from the center in Argentina where
this study was conducted.
- Paganini H, Gomez S, Ruvinsky S, et al.Outpatient,
Sequential, Parenteral-Oral Antibiotic Therapy for Lower Risk Febrile
Neutropenia in Children with Malignant Disease. Cancer 2003;97:1775-80.
- Petrilli AS, Dantas LS, Campos MC, et al.
Oral Ciprofloxacin vs. Intravenous Ceftriaxone Administered in an Outpatient
Setting for Fever and Neutropenia in Low-Risk Pediatric Oncology Patients:
Randomized Prospective Trial. Med Pediatr Oncol. 2000;34:87-91.