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Neutropenia and Cancer Infections / Hematological Disorders and Diagnostics / Blood Disorders and Treatments · Journal article
Antibiotics · August 13, 2026
Well-designed and adequately powered for the question it asks.
This randomized noninferiority trial found that reducing antimicrobial therapy in carefully selected children with febrile neutropenia and fever of unknown origin who show favorable early response is equivalent to maintaining full therapy, with 96% uneventful resolution in the maintain group and 95% in the adjust group. The narrow confidence interval around the relative risk (0.95–1.06) and zero absolute risk difference support noninferiority, suggesting a potential opportunity for antimicrobial stewardship in this population.
Prospective, multicenter, randomized, noninferiority trial. Children with cancer experiencing febrile neutropenia episodes catalogued as fever of unknown origin, recruited from eight hospitals in Chile between March 2021 and January 2024. Eligible patients had negative bacterial and viral studies with no clinical focus suggesting infection and favorable cli…. Intervention: Adjustment of antimicrobial therapy (reducing number and spectrum of agents). Compared with: Maintenance of current antimicrobial therapy. n = 231. Eight hospitals in Chile.
Uneventful resolution: 106/111 (96%) in maintain group versus 114/120 (95%) in adjust group (p = 1.00) Relative risk 1.01 (95% CI 0.95–1.06) and absolute risk difference 0.01 (95% CI −0.05–0.06) 266 of 939 febrile neutropenia episodes (28%) were catalogued as FUO
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians managing children with cancer and febrile neutropenia may consider safely reducing antimicrobial therapy in carefully selected cases with negative microbiological/molecular studies, no clinical focus of infection, and favorable early response, potentially reducing antibiotic exposure and resistance while maintaining safety.
Rigorous multicenter randomized noninferiority trial with adequate sample size and clear primary endpoint result showing equivalence between strategies, directly addressing a clinically relevant question in pediatric cancer care.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians managing children with cancer and febrile neutropenia may consider safely reducing antimicrobial therapy in carefully selected cases with negative microbiological/molecular studies, no clinical focus of infection, and favorable early response, potentially reducing antibiotic exposure and resistance while maintaining safety.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background/Objectives: The objective of this study is to evaluate the efficacy and safety of maintaining antimicrobial (AM) therapy or adjusting AM therapy during episodes of febrile neutropenia (FN) catalogued as a fever of unknown origin (FUO) in children with cancer. Methods: This is a prospective, multicenter, noninferiority, randomized study, approved by ethics committee, in children with episodes of FN in eight hospitals in Chile. Microbiological and molecular samples were drawn at admission. Patients with FUO (negative bacterial and viral study with no clinical focus suggesting infection) and favorable evolution during the first 48–72 h of AM therapy were randomized 1:1 to maintain or adjust treatment, reducing the number and spectrum of AMs. The primary endpoint was the percentage of episodes with an uneventful resolution; the secondary endpoints were the re-adjustment of AM therapy, days of fever/hospitalization/AM therapy, days of vancomycin and meropenem per 1000 days of neutropenia, number of AMs after randomization, pediatric intensive care unit (PICU) admission, sepsis, and death. Results: A total of 266 of 939 FN episodes recruited between March 2021 and January 2024 were catalogued as FUO, of which 231 had a favorable evolution at 48–72 h and were randomized, 111 to maintain and 120 to adjust AM therapy. Both groups presented the same percentage of uneventful resolution, with 106 (96%) in the group that maintain AM therapy and 114 (95%) in the adjusted group (p = 1.00); relative risk 1.01, (95%CI 0.95–1.06); absolute risk difference 0.01, (95%CI −0.05–0.06). Conclusions: The main finding of this study demonstrates that adjusting antimicrobial therapy appears safe in carefully selected FUO cases with a favorable early evolution, during episodes of FN catalogued as FUO in children with cancer. These findings open an opportunity to new AM stewardship strategies in this population, with a possible future impact on AM resistance.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.