Background: Intravenous antibiotic therapy is used for most children with febrile neutropenia (FN). For some children, therapy is completed with outpatient parenteral antibiotic therapy (OPAT). Adult data support step-down therapy to a quinolone-based oral antibiotic regimen for selected patients and recent pediatric FN guidelines recommend consideration of this strategy, but pediatric data are sparse. Because oral therapy is associated with lower costs and fewer adverse events compared to OPAT, we sought to evaluate the safety and feasibility of an oral step-down program for selected pediatric FN.
Methods: This was a retrospective pre-post study evaluating oral-step down therapy at discharge with levofloxacin for low-risk FN children. Eligibility criteria for oral therapy were: age >1 year, no documented bacteremia, anticipated neutropenia <7 days at discharge, afebrile >24 hours , and were tolerating an enteral diet. Informal discussion began in 2015; the formal practice change was implemented in September 2017. Intervention periods were defined as: pre-intervention (1/2014-3/2015), peri-implementation (3/2015-9/2017); post-intervention (10/2017-3/2018).The primary outcomes were was the percentage of FN patients who were discharged on oral levofloxacin and OPAT during each period. A secondary outcome was the percentage of patients readmitted within 7 days requiring receipt of IV antibiotics. Chi-square tests were used to compare outcomes between periods and statistical process control charts to monitor the changes during the intervention.
Results: During the pre-intervention period, 4/107 (3.7%) non-bacteremic FN were discharged on oral levofloxacin. This increased to 62/239 (26%) during the peri-implementation period and 37/68 (54%) during the post-implementation period (p<0.001) (Figure 1).The percentage of patients discharged on OPAT decreased from 74% in the pre-intervention to 9% in the post-intervention period (p<0.001). Readmission rates within 7 days of discharge receiving IV antibiotics in the 1st 24 hours were similar across the study periods (11%, 16% and 9% respectively; p = 0.19) (Figure 2).
Conclusion: An oral step-down program reduced OPAT use for low-risk pediatric FN with no change in readmissions
A. L. Hersh, None
E. Thorell, None
R. Lemons, None
A. Pavia, None
E. Knackstedt, None
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