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Some paediatric patients with cancer can be treated with antibiotic regimens of reduced intensity and duration
Jenny is an imaginary 4-year-old girl on maintenance treatment for acute lymphoblastic leukaemia. She gets a cold and a temperature of 38.3°C, and her parents take her to the local hospital. Examination shows no apparent cause of infection, but her temperature remains increased and her neutrophil count is low at 0.7×109/l. Today, in the UK, the manner in which local hospitals treat such an episode varies considerably. After appropriate investigation, including blood and urine cultures, Jenny may be sent home with a recommendation to return if she becomes unwell, or if her temperature continues over the next few days, she may be started on oral antibiotics as an inpatient, with discharge after 48 h, or she may be started on intravenous antibiotics with a view to discharge on oral antibiotics at 48 h, or she may stay in hospital on intravenous antibiotics for a minimum of 5 days. Compare this with how Jenny is treated with chemotherapy for her acute lymphoblastic leukaemia, receiving the same national treatment regimen regardless of where she lives. For most patients, the difference between approaches to treatment of febrile neutropenia is never noticed as children are treated consistently at their individual hospitals, but imagine the potential for confusion or uncertainty if Jenny becomes unwell when she goes to visit her Aunt Minnie in a different part of the country.
The striking variation across the UK in the treatment of febrile neutropenia exemplifies the lack of consistency between paediatric oncology centres in their protocols for supportive care. Some centres are already using strategies to identify episodes of febrile neutropenia where the risk of life-threatening complications is low (acute medical deterioration, admission to the intensive care unit or death …