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Japanese Journal of Clinical Oncology 34:69-73 (2004)
© 2004 Foundation for Promotion of Cancer Research

Randomized Trial of Oral Versus Intravenous Antibiotics in Low-risk Febrile Neutropenic Patients with Lung Cancer

Seiji Niho, Yuichiro Ohe, Koichi Goto, Hironobu Ohmatsu, Taketoshi Matsumoto, Kaoru Kubota, Ryutaro Kakinuma and Yutaka Nishiwaki+

Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan

Background: Neutropenic fever is one of the most serious adverse effects of cancer chemotherapy. Neutropenia may cause a life-threatening bacterial infection. Therefore, febrile neutropenic inpatients are empirically treated with intravenous broad-spectrum antibiotics. Recently, several studies have suggested the presence of low-risk groups among febrile neutropenic patients.

Methods: A prospective randomized trial was conducted to compare treatment with oral ciprofloxacin (200 mg) and amoxicillin-clavulanate (375 mg) administered every 8 h against that with intravenous ceftazidime (1 g) administered every 12 h in low-risk febrile neutropenic patients with lung cancer. All patients received chemotherapy and antibiotic therapy while being hospitalized.

Results: A total of 177 patients with lung cancer agreed to participate in this study prior to undergoing chemotherapy. Among them, a total of 36 neutropenic patients with 42 febrile episodes were enrolled in the study. Treatment was successful without the need for modification in 91% of the episodes in patients receiving the oral regimen and 79% of the episodes in patients receiving the intravenous regimen. No treatment-related deaths occurred. One patient developed nausea while receiving the oral regimen, so the oral regimen was changed to the intravenous regimen in this patient.

Conclusions: This prospective study suggested that treatment with oral antibiotics ciplofloxacin plus amoxicillin-clavulanate was effective for low-risk febrile neutropenic patients after chemotherapy.

+ For reprints and all correspondence: Seiji Niho, Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba 277-8577, Japan. E-mail: siniho{at}east.ncc.go.jp


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