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Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge

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Abstract

Goals of work

Patients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer (MASCC) score might benefit from ambulatory treatment. Optimal management remains to be clearly defined, and new oral antibiotics need to be evaluated in this setting.

Materials and methods

Cancer patients with febrile neutropenia and a favorable MASCC score were randomized between oral moxifloxacin and intravenous ceftriaxone. All were fit for early hospital discharge. The global success rate was related to the efficacy of monotherapy, as well as to the success of ambulatory monitoring.

Main results

The trial was closed prematurely because of low accrual. Ninety-six patients were included (47 in the ceftriaxone arm and 49 in the moxifloxacin arm). A total of 65% were women, 30.2% had lymphoma, 34.4% had metastatic, and 35.4% had non-metastatic solid tumors. The success rates of home antibiotics were 73.9% and 79.2% for ceftriaxone and moxifloxacin, respectively. Seven patients were not discharged, and 14 required re-hospitalization. There were 17% of microbiologically documented infections that were, in most cases, susceptible to oral monotherapy.

Conclusions

These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.

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Acknowledgement

This study was supported by a grant from Bayer Pharma France. We thank Dr. Pierre Arvise for the logistical and technical assistance; Giovanna Gonnon, Séverine Guillemaut, and Mathieu Cassin for the help in the study design, study monitoring, and data analysis; Carlos Poncelas for the help in the management of outpatient treatment; and Marie-Dominique Reynaud for the editorial assistance.

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Authors and Affiliations

  1. Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France

    Catherine Sebban, Sophie Dussart, Christine Fuhrmann, Hervé Ghesquieres, Yves Devaux, Laurence Lancry, Giselle Chvetzoff, Thomas Bachelot, Maria Chelghoum & Pierre Biron

  2. Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France

    Isabelle Rodrigues

  3. Centre Alexis Vautrin, 6 avenue de Bourgogne Brabois, 54500, Vandoeuvre les Nancy, France

    Lionel Geoffrois

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  1. Catherine Sebban
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  2. Sophie Dussart
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  3. Christine Fuhrmann
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  12. Pierre Biron
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Correspondence to Catherine Sebban.

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Sebban, C., Dussart, S., Fuhrmann, C. et al. Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge. Support Care Cancer 16, 1017–1023 (2008). https://doi.org/10.1007/s00520-007-0383-z

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  • DOI: https://doi.org/10.1007/s00520-007-0383-z

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