Febrile Neutropenia: Current Practice Within the US Pediatric Population

Empiric antibiotics have been proven efficacious in reducing mortality in patients with febrile neutropenia (FN). However, most research does not establish a time frame for appropriate cessation of antibiotics if the patient lacks an actual infection. Guideline recommendations also differ for discontinuing empiric therapy, either stopping based on time or based on marrow recovery. Due to pediatric Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia causing more severe marrow suppression than most adult cancers, this patient population needs further research into the management of their FN. Recruitment of participants occurred through email-based off contacts from online pediatric pharmacist directories. Participants were screened to ensure duplicate entries from the same hospital were excluded. Analysis of results compared overall response and region-specific trends. Sixty-three responses were collected, with 37 surveys included. Varying guidelines were used to create protocols at hospitals, most commonly the Infectious Diseases Society of America’s FN guideline at 78% of responses. Fifty-one percent of hospitals indicated that neutrophil recovery was necessary to stop empiric antibiotics in clinically stable pediatric FN cases. Twelve facilities did not require neutrophil recovery, but instead relied upon hours of being afebrile, ranging from 24-72 hours. The majority of hospitals also had antimicrobial stewardship program involvement (67%). Variation continues to exist regarding the duration of antimicrobial therapies for pediatric FN, however, most hospitals utilize neutrophil recovery and duration of being afebrile into their considerations. Further studies are needed to determine optimal durations and what role stewardship programs should have to help limit unnecessary durations of therapy.