Safety and efficacy of short courses of antibiotic therapy in high-risk febrile neutropenic pediatric patients

The majority of children and adolescents treated for acute leukemia experiences at least one infectious episode during neutropenia [ 1 ]. According to pediatric-specific guidelines, these patients are promptly hospitalized and receive empirical broad-spectrum antibiotics [ 2 , 3 ], which further impairs the quality of life of patients and increases the risk of resistant pathogens [ 4 ]. Pediatric-specific guidelines strongly recommend for both high- and low-risk patients who have been clinically well, are afebrile for at least 24 h and have negative blood cultures at 48–72 h, to discontinue empirical antibiotic therapy if there is evidence of marrow recovery [ 3 ]. However, only in low-risk febrile neutropenic patients, a conditional recommendation was made for the discontinuation of antibiotics in this setting when there is no evidence for marrow recovery. We expanded the recommendation to stop empirical antibiotic therapy irrespective of hematological recovery in our institution to high-risk patients defined by long periods of therapy-induced neutropenia (e.g., ≥10 days) [ 5 , 6 ], such as patients with high-risk acute lymphoblastic leukemia (HR-ALL), acute myeloid leukemia (AML) or relapsed acute leukemia, and performed a retrospective audit to assess safety (e.g., mortality) and efficacy (e.g., readmission) of this approach. This retrospective, single-center audit evaluated all consecutive patients 500/µl). First line antibiotic therapy, the strategy of antibiotic discontinuation and hospital discharge did not differ between first admission and readmission for a febrile neutropenic episode. Statistical analysis was performed using SPSS 29.0 (IBM, USA). Comparisons were performed by t test, Wilcoxon signed-rank test, Mann–Whitney U test, and Chi- square test, as applicable. P values