1. Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice.
- Author
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Haeusler GM, Slavin MA, Bryant PA, Babl FE, Mechinaud F, and Thursky KA
- Subjects
- Adolescent, Ambulatory Care methods, Ambulatory Care standards, Anti-Bacterial Agents therapeutic use, Australia, Child, Child, Preschool, Combined Modality Therapy, Drug Therapy, Combination, Female, Fever etiology, Health Care Surveys, Humans, Male, Medical Audit, Neutropenia etiology, New Zealand, Pediatrics standards, Pediatrics statistics & numerical data, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Quality Assurance, Health Care, Quality Improvement, Risk Assessment, Fever therapy, Guideline Adherence statistics & numerical data, Neoplasms complications, Neutropenia therapy, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Aim: Variation in the management of fever and neutropenia (FN) in children is well described. The aim of this study was to explore the current management of FN across Australia and New Zealand and highlight areas for improvement., Methods: A practice survey was administered to paediatric health-care providers via four clinical and research networks. Using three clinical case vignettes, we explored risk stratification, empiric antibiotics, initial investigations, intravenous-oral switch, ambulatory management and antibiotic duration in children with cancer and FN., Results: A response was received from 104 participants from 16 different hospitals. FN guideline compliance was rated as moderate or poor by 24% of respondents, and seven different fever definitions were described. There was little variation in the selected empiric monotherapy and dual-therapy regimens, and almost all respondents recommended first-dose antibiotics within 1 h. However, 27 different empiric antibiotic combinations were selected for beta-lactam allergy. An incorrect risk status was assigned to the low-risk case by 27% of respondents and to the high-risk case by 41%. Compared to current practice, significantly more respondents would manage the low-risk case in the ambulatory setting provided adequate resources were in place (43 vs. 85%, P < 0.0001). There was variation in the use of empiric glycopeptides as well as use of aminoglycosides beyond 48 h., Conclusion: Although the antibiotics selected for empiric management of FN are appropriate and consistent, variation and inaccuracies exist in risk stratification, the selection of monotherapy over dual therapy, empiric antibiotics chosen for beta-lactam allergy, use of glycopeptides and duration of aminoglycosides., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)
- Published
- 2018
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