Supportive Care in Cancer

, Volume 20, Issue 6, pp 1135–1145 | Cite as

Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

  • A. Manji
  • J. Beyene
  • L. L. Dupuis
  • R. Phillips
  • T. Lehrnbecher
  • L. SungEmail author
Review Article



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.


Cancer Children Febrile Meta-analysis Neutropenia 



We would like to thank Elizabeth Uleryk for her gracious assistance and expertise in conduct of the literature search. We also would like to acknowledge Rhonda Adams for her administrative assistance.

LS is supported by a New Investigator Award with the Canadian Institutes of Health Research.

Conflict of interest

There are no conflicts of interest to declare.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • A. Manji
    • 1
    • 2
  • J. Beyene
    • 3
    • 4
    • 5
  • L. L. Dupuis
    • 1
    • 6
    • 7
  • R. Phillips
    • 8
  • T. Lehrnbecher
    • 9
  • L. Sung
    • 1
    • 3
    • 5
    Email author
  1. 1.Division of Haematology/OncologyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Division of Clinical Pharmacology & ToxicologyThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Program in Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoCanada
  4. 4.Program in Population Genomics, Department of Clinical Epidemiology & Biostatistics, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  5. 5.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Department of PharmacyThe Hospital for Sick ChildrenTorontoCanada
  7. 7.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  8. 8.Leeds Teaching Hospitals, NHS TrustSt. James’s University HospitalLeedsUK
  9. 9.Pediatric Hematology/OncologyJohann Wolfgang Goethe-University HospitalFrankfurtGermany

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