Management and treatment of febrile neutropenic episodes in children with cancer

Although main therapy principles of febrile neutropenic episodes in childhood cancers are determined, each institution has to overwiev its own data, periodically in aspects of changes upon infectious influences and institution depended factors. The objective of this study is to evaluate our data on febrile neutropenic episodes, infectious agents, success of treatment algorythms and treatment costs to form a more accurate treatment protocol for forthcoming years. PATIENTS AND METHODS: 96 febrile neutropenic episodes, diagnosed between January,18,,1996 and May,31sl, 2001, have been overwieved. Factors affecting treatment success and cost have been analysed by evaluating infection focuses, infectious agents, first step empirical treatment algorythms, modifications on treatment, supportive therapies, success and cost of treatment modalities used for all 96 febrile neutropenic episode cases. RESULTS: Within mentioned period, equal number of episodes were observed in both lymphoproliferative and solid tumor groups. In 87% of those cases, absolute neutrophil counts were below 500/mm3. In solid tumor group, episodes were more frequent and estimated neutropenic period was longer. In 34% of episodes, no infection focus was detected whereas most focuses were on mucosal surfaces and gastrointesinal system. Infectious agents were microbiologically identified in 15% of the cases and Gram negatives, which were responsible for 56% of the identified causes. Five cases had bacteremia, and three of them were Gram positives. Empirical therapy mostly were used, double combined therapy (70%), including, ceftazidime and amikacin in 44 episodes, carbapenem and amikacin in 18 episodes. In 6% of episodes, monotherapy was used. In 4%, glycopeptide, in 18% antifungal and in 2% antiviral drug was added to empirical treatment. Empirical treatment success was 51% and higher in the solid tumor group. Fever was controlled in 59% of the patients in first 72 hours, 80% of them in five days and none of the patients of died in the study group. In lymphoproliferative tumor and longer neutropenic period group, control of fever took more time. Applying haematopoietic growth factor added no benefit. Mean treatment cost for each patient was 1506 USD. Treatment costs were much more in patients, who had lymphoproliferative tumor, accompanied bacteremia, for which carbapenem and amikacin used and antiviral drugs added, growth factors used in therapy and modification on treatment was made. CONCLUSION: Empirical treatment success was 51% in our study group and overall treatment success was 100% because no death occured. The most appropriate treatment modality included ceftazidime and amikacin combination which has more effect and low cost. Key words: Neutropenic fever, childhood cancers, neutropenia.