COMPARISON OF ANTIBIOTICS;

GRANULOCYTE COLONY-STIMULATING FACTOR IN CHILDREN WITH CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA

Abstract

Objective: To determine if granulocyte colony-stimulating factor (G-CSF) with
empirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibiotics
without it. Study design: Experimental study. Place and Duration of Study: Study was
conducted for a period of one year from march 2012 to february 2013 in oncology/haematology
department Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 children
with febrile neutropenia due to chemotherapy were included in the study. Two groups were made
A and B. Twenty eight patients were included in each group. Patients included in the group A
were given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five days
and the patients included in group B were not given granulocyte colony stimulating factor.
Subcutaneous administration was recommended. Patients remained on study until absolute
neutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groups
was given antibiotic treatment in the hospital whenever there is need, antibiotics changed
according to the blood culture sensitivity. Admitted patients were followed daily for fever and
signs of sepsis. Number of days of admission in hospital and number of days of treatment was
calculated in both groups and compared with each other. Duration of febrile neutropenia and
mortality was also analysed for both groups. Results: Out of 56 patients 46 had acute
lymphoblastic leukemia (ALL), 06 patients were of wilm tumour and 04 patient were having
rhabdomyosarcoma. Twenty eight patients were given only antibiotics(GROUP B) and 28
patients were given G-CSF plus antibiotics(GROUP A). Addition of G-CSF significantly reduced
neutropenia and febrile neutropenia recovery times. Median days to febrile neutropenia
resolution was 4.3 days earlier with G-CSF (5.3 vs. 9.6 days) (P < 0.0001). Resolution of fever was
one day earlier in patients who were given G-CSF (GROUP A). Hospitalization was 2.1 days
shorter with G-CSF (6.1 vs. 8.2 days) (P = 0.02). (Table II). There was difference of 2.2 days in the
duration of IV and oral antibiotic treatment. Addition of antifungal therapy was done in 4 patients
in group B and only in one patient in group A. All the patients recovered and no death occurred in
the study. Conclusions: It is concluded that addition of G-CSF to empiric antibiotic therapy
accelerates chemothserapy-induced febrile neutropenia resolution by 4.3 days in pediatric
patients with malignancy. It is a significant difference in duration of hospitalization. By bearing
expenses of G-CSF we can decrease the expenses of hospitalization and antibiotics