F/N is a frequent complication of treatment in a child with cancer; management is controversial and variable. We surveyed 70 pediatric oncology programs (POP) to determine the prevalent approach to this problem. Of those surveyed, 80% responded representing an annual accrual of about 5000 new oncology patients (pts). Analysis of the data showed that criteria for antibiotics (Ab) are temperature between 38°C and 38.5°Ca and absolute neutrophil count (ANC) <500 (55%) with 34% using <1000 and 11% using <200. 91% of POP stop Ab after 3 days (d) if pts are afebrile with no documented infection (DI) and ANC now >500. However, if the ANC remains <500, 88% of POP continue Ab (for 7-14d or until ANC >500-1000 regardless of duration) even in the absence of fever or DI. Only 9% treat for 3 days, Duration of Ab for pts with DI averages 103 (range 7-14) depending on the site if ANC >500. Thus most POP treat pts with F/N as if infected whether inf is documented or not. In neutropenic pts on Ab with persistent fever but no source 62% start amphotericin (ampho) 7d and 19% after >7d. 11% have no specific indications and 8% don't use ampho. After an afebrile period 55% do not treat recurrence of fever with ampho. Once started duration of treatment with ampho is extremely variable. There was good agreement among POP for F/N occurring during administration of blood product or chemotherapy known to cause fever. 65% culture and observe only; 16% treat with Ab until cultures are negative; 11% wait until ANC >500. On the use of trimethoprim/sulfamethoxazole (TM) or mycostatin (My) prophylactically during induction/consolidation: 30% do not use TM even for leukemia and 75% do not use My at all. In conclusion, although there are published guidelines and informal discussion of treatment of F/N, this study documents the acceptance of and adherence to these recommendations and defines the currently practiced standards of care. It defines fruitful areas for further clinical investigation.
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Miller, L., Miller, D. MANAGEMENT OF FEVER/NEUTROPENIA (F/N) IN CHILDREN WITH CANCER: A NATIONAL SURVEY. Pediatr Res 21, 302 (1987). https://doi.org/10.1203/00006450-198704010-00809