Ceftriaxone fails to impress in non-neutropenic fever in children with cancer

Nearly half of non-neutropaenic fever episodes in children with cancer are associated with respiratory symptoms, according to a recent study. Of note, ceftriaxone monotherapy has a high failure rate in these patients.

The authors retrospectively analysed the efficacy of the current clinical approach for management of non-neutropaenic fever episodes and the associated risk factors among children with cancer at the Princess Noorah Oncology Center in Jeddah, Saudi Arabia, from May 2016 through December 2017.

Overall, 480 non-neutropaenic fever episodes occurred in 131 children, of which 62 episodes were triaged as high-risk and 418 as low-risk non-neutropaenic fever. In addition, 361 (75.2 percent) of the 480 episodes correlated with the presence of central venous catheters.

The overall failure rate of ceftriaxone monotherapy stood at 75.6 percent: 11.7 percent in high-risk non-neutropaenic fever with a mean C-reactive protein (CRP) level of 21.1 mmol/L and 63.9 percent in low-risk non-neutropaenic fever with a mean CRP level of 17.6 mmol/L.

For bacteraemia, the overall rate was 14.4 percent. The type of organisms was primarily high-risk in 59 non-neutropaenic fever episodes (85.5 percent; odds ratio [OR], 1.78, 95 percent confidence interval [CI], 0.45–7.04; p=0.41). Notably, all bacteraemia (100 percent) correlated with the presence of central venous catheter.

The only risk factor of outpatient treatment failure in low-risk non-neutropaenic fever that was significantly associated with bacteraemia was prolonged fever of more than 3 days (OR, 8.107, 95 percent CI, 1.744–37.691; p=0.008). In addition, about 43 percent of non-neutropaenic fever episodes were associated with respiratory symptoms.

“This study provides a baseline for future prospective research assessing the pattern of non-neutropenic fever by focusing on associated risk factors,” the authors said.