Oral Ciprofloxacin Compared with Intravenous Ceftazidim on Low Risk Febrile Neutropenia in Acute Lymphocytic Leukemia

Abstract Objective Fever and neutropenia are a common complication of chemotherapy in cancer. It is usually managed by hospitalization and empiric administration of antibiotics. Use of Fluroquinolones is limited because of joint/cartilage toxicity. This study attempted to compare the efficacy of oral ciprofloxacin with intravenous ceftazidim in low risk febrile neutropenic lymphocytic leukemia. Methods Ninety two episodes of febrile neutropenia in 72 patients under 14 years old were studied prospectively for two years. All the patients received G-CSF plus intravenous ceftazidim 100 mg/kg/d and amikacin 15 mg/kg/d for 24 hours. These episodes randomly allocated into two groups. Group A received IV ceftazidim and amikacin for at least 3 days. After discharge they got oral cefixim 8 mg/kg daily. Group B discharged and received oral ciprofloxacin (20 mg/kg.day) for seven days. Failure was defined as temperature higher than 38 °C for more than 72 hours or major complication. Results Failure of intravenous ceftazidim plus amikasin for at least 4 days in hospital, in low risk febrile neutropenic children, was 6.5%, but failure of oral ciprofloxacin for 7 days after 24h intravenous ceftazidim plus amikasin was 4.3%. There was no arthrotoxicity in patients received ciprofloxacin. Conclusion Empirical therapy with oral ciprofloxacin is safe and effective in children with leukemia and low risk FN.