A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy

Alison Freifeld, Donna Marchigiani, Thomas Walsh, Stephen Chanock, Linda Lewis, John Hiemenz, Sharon Hiemenz, Jeanne E. Hicks, Vee Gill, Seth M. Steinberg, Philip A. Pizzo

Research output: Contribution to journalArticle

Abstract

Background: Among patients with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral administration of empirical broad-spectrum antibiotics may be an acceptable alternative to intravenous treatment. Methods: We conducted a randomized, double-blind, placebo-controlled study of patients (age, 5 to 74 years) who had fever and neutropenia during chemotherapy for cancer. Neutropenia was expected to be present for no more than 10 days in these patients, and they had to have no other underlying conditions. Patients were assigned to receive either oral ciprofloxacin plus amoxicillin-clavulanate or intravenous ceftazidime. They were hospitalized until fever and neutropenia resolved. Results: A total of 116 episodes were included in each group (84 patients in the oral-therapy group and 79 patients in the intravenous-therapy group). The mean neutrophil counts at admission were 81 per cubic millimeter and 84 per cubic millimeter, respectively; the mean duration of neutropenia was 3.4 and 3.8 days, respectively. Treatment was successful without the need for modifications in 71 percent of episodes in the oral-therapy group and 67 percent of episodes in the intravenous-therapy group (difference between groups, 3 percent; 95 percent confidence interval, -8 percent to 15 percent; P=0.48). Treatment was considered to have failed because of the need for modifications in the regimen in 13 percent and 32 percent of episodes, respectively (P

Original languageEnglish (US)
Pages (from-to)305-311
Number of pages7
JournalNew England Journal of Medicine
Volume341
Issue number5
DOIs
StatePublished - Jul 29 1999
Externally publishedYes

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Neutropenia
Fever
Group Psychotherapy
Anti-Bacterial Agents
Drug Therapy
Neoplasms
Therapeutics
Clavulanic Acid
Ceftazidime
Amoxicillin
Ciprofloxacin
Oral Administration
Neutrophils
Placebos
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. / Freifeld, Alison; Marchigiani, Donna; Walsh, Thomas; Chanock, Stephen; Lewis, Linda; Hiemenz, John; Hiemenz, Sharon; Hicks, Jeanne E.; Gill, Vee; Steinberg, Seth M.; Pizzo, Philip A.

In: New England Journal of Medicine, Vol. 341, No. 5, 29.07.1999, p. 305-311.

Research output: Contribution to journalArticle

Freifeld, A, Marchigiani, D, Walsh, T, Chanock, S, Lewis, L, Hiemenz, J, Hiemenz, S, Hicks, JE, Gill, V, Steinberg, SM & Pizzo, PA 1999, 'A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy', New England Journal of Medicine, vol. 341, no. 5, pp. 305-311. https://doi.org/10.1056/NEJM199907293410501
Freifeld, Alison ; Marchigiani, Donna ; Walsh, Thomas ; Chanock, Stephen ; Lewis, Linda ; Hiemenz, John ; Hiemenz, Sharon ; Hicks, Jeanne E. ; Gill, Vee ; Steinberg, Seth M. ; Pizzo, Philip A. / A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. In: New England Journal of Medicine. 1999 ; Vol. 341, No. 5. pp. 305-311.
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AU - Hiemenz, John

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