Early Stoppage Versus Continuation of Antimicrobial Therapy in Low Risk Pediatric Cancer Patients With Febrile Neutropenia, Before Recovery of Counts: -DALFEN Study
Early Stoppage Versus Continuation of Antimicrobial Therapy in Low Risk Pediatric Cancer Patients With Febrile Neutropenia, Before Recovery of Counts: -DALFEN Study
Pediatric patients with febrile neutropenia coming to Department of Medical Oncology with low
 risk features (culture awaited), will be started on intravenous antibiotics (Inj
 Cefoperazone+ Sulbactam ± Amikacin) on outpatient basis. Those patients will be reassessed
 for randomization once they fulfill all inclusion criteria and get afebrile for at least 24
 hours. Antibiotics will be stopped in Arm-A and oral antibiotics, in place of intravenous
 antibiotics, will be started in Arm-B. The patients will be followed-up till ANC≥ 500, or
 reappearance of fever within follow-up of ≤ 10 days.
Inclusion Criteria:

 -  All pediatric febrile neutropenia patients treated on outpatient basis

 -  Age 3 years - 18 years

 -  Fulfilling low risk criteria ( Hematological malignancies in remission, No
 identifiable focus of infection, No Pneumonia/ mucositis / GI sepsis /
 Nausea-vomiting/ neurologic-mental status changes/ Central Venous Catheter (CVC)
 related infection, Anticipated Absolute Neutrophil Count (ANC) recovery ≤ 10 days, No
 organ dysfunction, Hemodynamically stable, Culture negative )

 -  Afebrile for at least 24 hours, on intra-venous antibiotics

 Exclusion Criteria:

 -  Bone marrow involvement in solid tumor

 -  Already enrolled once, in previous episode

 -  On antibiotics prophylaxis

 -  Retroviral positive patients

 -  Patient undergone stem cell transplant