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In Reply

Institut Jules Bordet, Brussels, Belgium

We thank Dr Ouvrier and colleagues for their interest and their comments about our article dealing with outpatient oral antibiotics for febrile neutropenia in predicted low-risk patients. ¹

First of all, primary objective of our work was to assess whether it was safe to discharge febrile neutropenic patients predicted at low-risk of serious medical complication on the basis of a standardized tool from the hospital early. When we designed our research protocol, two options were possible: either to discharge patients immediately after oral treatment initiation or to admit them to the hospital for a short surveillance. In the last situation, which we adopted for obvious safety reasons, it was logical not to consider early discharge for patients who were not in, at least, stable medical condition after 24 hours. However, clinical deterioration was not the only reason for keeping a patient in the hospital, but there were many others as described in our article: patient's refusal, physician's anxiety, and inadequate environment at home.¹ Therefore, we believe that the question of complications development rates among those early discharged and among those kept in the hospital was a relevant question although it was a secondary objective with exploratory purposes as it assesses the usefulness of the in-hospital surveillance at the very beginning of the febrile episode.

Regarding the choice of our outcome, we did not look at success of the initial empiric oral antibiotic regimen but at overall success of our strategy (ie, the lack of serious medical complications development including death). As the outcome we considered was binary, we would have gotten exactly the same sample size and the same conclusions, should we have looked at strategy failure as being defined by serious medical complication development including death and the need for hospital readmission during the course of the febrile episode for the shift of oral antibiotic treatment to intravenous treatment or for any other reason (ie, a definition compatible with the one recommended by).²

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Klastersky J, Paesmans M, Georgala A, et al: Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24:4129-4134, 2006[Abstract/Free Full Text]

2. Vidal L, Paul M, Ben dor I, et al: Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients: A systematic review and meta-analysis of randomised trials. J Antimicrob Chemother 54:29-37, 2004[Abstract/Free Full Text]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Paesmans, M. Articles by Klastersky, J. Search for Related Content PubMed Articles by Paesmans, M. Articles by Klastersky, J. Social Bookmarking                            What's this?