Evaluation of Guideline for Treatment of Febrile Neutropenia in Pediatric Cancer at Siriraj Hospital
Kleebsabai Sanpakit MD*, Kamon Phuakpet MD*, Gavivann Veerakul MD*, Nattee Narkbunnam MD*, Kulkanya Chokephaibulkit MD
Affiliation : *Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Background : Febrile neutropenia (FN) is a common and important clinical problem in pediatric cancer. Our
Institution has developed a clinical practice guideline (CPG) for treatment of FN to assist the clinicians
taking care of these patients.
Objective : To evaluate characteristics of FN, sources and causative agents of infection, applicability and
effectiveness of the CPG, and factors that associated with response to treatment.
Materials and Methods : The medical records of patients with FN that had completed data from September,
2003 to May, 2005 were reviewed and analysed.
Results : A total of 148 FN episodes in 90 patients were analysed. The predominant underlying malignancy
was acute leukemia. About 50% had absolute neutrophil count (ANC) less than 100 cells/mm3 at the begin-
ning and at reassesment on day 3 of treatment. The causes of infection with microbiological confirmation was
25%. Urinary tract infection was the predominant source of infection and gram negative bacteria was the
predominant causative agent. Sixty-two percents responded to initial treatment without changing of antibiot-
ics. Of all episodes, 91.2% were able to complete treatment according to the CPG. The mortality rate was 1.4%.
ANC of less than 100 cell/mm3 on day 3 of treatment was the significant risk factor for prolonged duration of
fever and unresponsiveness to low risk regimen of antibiotics. ANC of less than 100 cell/mm3 on day 3, having
hematologic malignancies, and recurrent fever were associated risks for the need for antifungal agent or
referral to infectious diseases specialist or death. The pretreatment ANC more than 100 cells/mm3 was a
significant predictor for the responsiveness to low risk regimen without recurrent fever.
Conclusion : Our CPG could practically be applied in FN patients and resulted in low mortality rate.
Keywords : Clinical Practice Guideline, Febrile neutropenia, Pediatric cancer
