Early Discontinuation of Empiric Antibiotic Therapy in Children with Cancer and Febrile Neutropenia: A Narrative Review

TL;DR

This review examines the safety and benefits of stopping antibiotics early or discharging children with cancer and febrile neutropenia early, finding these approaches may be safe for low-risk cases.

Contribution

The paper provides a comprehensive narrative review of evidence on early antibiotic discontinuation and early discharge in pediatric cancer patients with febrile neutropenia.

Findings

Early discontinuation of antibiotics and early discharge are safe for selected low-risk febrile neutropenia cases.

These strategies reduce hospital stays and antibiotic use, with potential economic benefits.

High-quality evidence and standardized criteria are needed for broader clinical adoption.

Abstract

Background and Objectives: Febrile neutropenia (FN) is a potentially life-threatening complication in children undergoing cancer treatment. Immediate initiation of empirical antibiotic treatment (EAT) has improved the prognosis and outcomes of FN. Although the ideal timing for initiating EAT is clear, the optimal timing for EAT discontinuation remains debatable. Early hospital discharge (EHD) with continuation of oral antibiotics has also been proposed as an alternative strategy. This narrative review aims to present a comprehensive overview of the evidence on early discontinuation of EAT or EHD in children with FN and cancer. Materials and Methods: A comprehensive literature search was performed to identify relevant studies assessing early EAT discontinuation or EHD in children with cancer and FN. Extracted data included the safety outcomes, the benefits for the patients and the cost for healthcare systems. Results: Thirty-one studies were included; twenty-one investigated the early discontinuation of EAT and ten studies evaluated EHD. Most studies reported early discontinuation of EAT or EHD as a safe FN treatment approach with potential benefits for the patients, especially when applied to selected low-risk FN cases. Reported benefits included shorter hospitalization duration and reduced antibiotic use, with additional economic advantages in several studies. Conclusions: Early discontinuation of EAT appears to be a safe and beneficial management approach for children with FN and cancer by reducing the length of hospital stay and the duration of antibiotic use. EHD with oral therapy continuation also appears to be safe but less beneficial than early discontinuation of EAT. High-quality evidence and standardized criteria are needed to support broader implementation of these strategies in routine clinical practice.

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