Antibiotics for febrile neutropenia

Febrile neutropenia is when a person with cancer develops a fever when their neutrophils are depleted during drug treatment.

This puts them at risk for severe infections and even death.

It is treated with broad-spectrum antibiotic therapy, but the recommended duration of antibiotic therapy currently varies among guidelines.

The referenced article seems to be aimed at assessing the relationship between the duration of antibiotic therapy and neutrophil depletion, as well as the emergence of resistant bacteria.

Conclusion.

We found that there was no significant change in symptoms when antibiotics were administered for different periods of time, either short-term or long-term.

There was some data that short-term antibiotic treatment resulted in fewer days of fever compared to long-term treatment, but this cannot be said to be confirmed due to bias.

About the study.

People with neutropenia and fever were included in the study.

Eight studies were included, including a comparison of short-term antibiotic therapy with long-term antibiotic therapy until neutrophils normalized.

A total of 662 febrile episodes in neutropenic people were randomly assigned to treatment groups. A total of 662 fever episodes in people with neutropenia were randomly assigned to treatment groups (314 to short-term antibiotic therapy and 348 to long-term antibiotic therapy).

All studies excluded people who had bacterial growth prior to randomization.

All but two of the studies excluded people with infections of specific organs.

There did not seem to be any difference in mortality between the short- and long-term antibiotic therapy groups.

There was no difference in the number of people with severe infections that manifested as bacteria in the blood.

In those who received short antibiotic therapy, compared to those who received long antibiotic therapy.

Although there were more cases of infections with positive cultures, there was no difference in the rate of unfavorable outcomes, such as recurrent fever, need for rehospitalization, or change or restart of antibiotics.

A positive culture means the presence of live fungi.

From this study, they found no difference in the rate of fungal infection and the development of antibiotic resistance.

Compared to people treated with a long course of antibiotics. There were fewer days with fever for those treated with the short antibiotic course, compared to those treated with the long antibiotic course.

In all trials, the number of days on antibiotics was higher in the short-term antibiotic therapy group than in the long-term antibiotic therapy group. The short-term antibiotic therapy group had 3 to 7 fewer days.

The data on length of hospital stay was insufficient to draw meaningful conclusions.

Reviewer's comment.

The existing evidence and its lack of certainty did not allow us to draw strong conclusions about the safety of discontinuing antibiotics before resolution of neutropenia in cancer patients with febrile neutropenia. The results of microbiological outcomes favoring long-term antibiotic therapy may be misleading because of the low culture positivity rates under antibiotic therapy and not because of any real difference in infection rates. In an era of increasing antibiotic resistance, there is a need for well-designed and properly functioning RCTs to address this issue.

Early discontinuation of antibiotics for febrile neutropenia versus continuation until resolution of neutropenia in people with cancer.A A A, Carrara E, Bitterman R, Yahav D, Leibovici L. Cochrane Database of Systematic Reviews 2019, No. 1. Number: CD012184. doi: 10.1002 / 14651858.CD012184.pub2.

You know that antibiotics kill bacteria, but the conclusion was that there was no significant change in the short or long term.

One of the symptoms that can appear during cancer treatment is febrile neutropenia, but Hygiene measures seem to be used as a countermeasure.

To prevent this, hygiene measures such as hand washing, gargling, and alcohol disinfection of hands are used.

If the disease develops, antibacterial agents and antipyretics are the treatment of choice.

This article is not very useful for my knowledge.

I didn't even know about febrile neutropenia and the symptoms that might appear if I thought carefully about how to treat cancer.

I introduced it for such reconfirmation.