Management of Febrile Neutropenia in Children with Cancer

Febrile neutropenia (FN) is the most common complication of childhood cancer treatment with mortality rates of untreated patients up to 21%. The recognition and management of FN is fundamental to preserve the children health status and avoid life-threatening complications. Physical and laboratory assessments should be performed in every patient with FN to identify any potential site of infection to be promptly treated. Hence, an empiric antimicrobial therapy remains the gold standard for the management of these patients. Antimicrobial treatment should be based on local epidemiological data and antibiotic susceptibility; a combination of a fourth-generation antipseudomonal cephalosporin with an aminoglycoside is generally adopted. Empirical administration of glycopeptides, in absence of documented Gram-positive bacterial infection is not recommended for routine use. Despite the progress in the management of febrile neutropenia and its relatively low mortality, the emergence of resistant pathogens is increasing, and the development of new effective antimicrobials are needed. Established criteria for a risk adapted approach is still lacking and no definitive data supporting the duration of empiric treatment are present. De-escalation strategies should be implemented to reduce both antibiotic exposure and resistance as well as hospital stay.