Objective: To evaluate the efficacy and safety of oral antibiotics for the management of selected “low-risk” patients admitted for management of FNE. Method: Patients admitted with fever and chemotherapy induced neutropenia were considered “low risk” if they: i) became afebrile within 24 to 96 hours following admission, ii) had negative blood and line cultures, iii) had no current detectable bone marrow disease and iv) were considered clinically well. Low risk patients were eligible to be switched to oral antibiotics (Cefixime 8 mg/kg/day and flucloxacillin 100 mg/kg/day), 24 hours after their last temperature > 38.0 °C. Data was collected on all patients discharged on oral antibiotics following admission for a FNE. Results: Between April 1993 and August 1994, 150 children were admitted to HSC for management of 254 FNE's. In 79 episodes (31%), the children were discharged on oral antibiotic therapy. Of the remaining 175, 11 (6.3%) either refused oral antibiotic therapy (5) or were unable to tolerate oral medications (6), 32(18%) had bacteremia (18) or a local infection (14) requiring intravenous antibiotic therapy, 42 (24%) had prolonged fever, 26 (15%) still had bone marrow involvement and 45 (26%) resolved both their neutropenia and fever within the initial time period. Of those discharged on oral antibiotic therapy, 57 (72%) met the criteria for being low risk (group 1). Of the 22 that did not meet the criteria (group 2) 18 had prolonged fever and antibiotic therapy prior to being switched to oral antibiotics and 4 were switched when they were less than 24 hours from their last elevated temperature. Ten patients were readmitted for recurrent fever while still neutropenic; 6 patients (11%) were in group 1 compared with 4 patients (18%) in group 2(p = n.s.). All patients that were readmitted did well with no unusual morbidity. One patient in group 2 had a central venous line culture positive for coagulase negative Staphylococci at the time of recurrent fever but did well with antibiotic therapy. Conclusions: i) Cefixime and flucloxacillin are efficacious, well tolerated and safe when used in this fashion, ii) patients with low risk FNE can be discharged safely on oral antibiotic therapy and iii) the definition of low risk as used here may be too stringent. This study was funded by Lederle Laboratories Division, Cyanamid Canada Inc. (Wyeth-Ayerst)