International Panel Creates Management Guideline for Pediatric Fever, Neutropenia

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(ChemotherapyAdvisor) – An international panel has developed an evidence-based guideline for the empiric management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation, according to an article in the Journal of Clinical Oncology online September 17.

Citing a “critical gap” in guidelines specifically focused on children with cancer, the International Pediatric Fever and Neutropenia Guideline Panel comprising pediatric oncology and infectious disease experts, representatives from nursing and pharmacy, and a patient advocate was convened. Working groups developed key clinical questions, conducted systematic literature reviews, and compiled evidence summaries.

The recommendations focus on the initial presentation of fever and neutropenia, including risk stratification, initial evaluation, and treatment; ongoing management, such as modification and cessation of empiric antibiotics; and empiric antifungal treatment. Graded strength (1=strong and 2=weak) and levels of evidence (A=high, B-moderate, C=low or very low) are presented for each recommendation.

“Some recommendations are similar to those of adult guidelines, such as choice of empiric antibacterials and criteria for their modification,” the panel wrote. “Some similar recommendations have benefitted from a pediatric-specific focus, such as consideration of outpatient management and oral antibacterial therapy."

“However, there are key distinctions. For example, the proposed risk stratification schemas are pediatric specific, and a number of diagnostic tools such as BG [beta-D-glucan] testing have pediatric-specific limitations. These factors have an important impact on the care of pediatric patients.”

Research gaps in pediatric fever and neutropenia were also identified.

“Future iterations of this guideline will need to incorporate evolving and emerging evidence as research is conducted in pediatric fever and neutropenia,” they concluded.


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