Pharmaceutical interventions in the management of febrile neutropaenia in paediatric oncology

Abstract

The basis of treatment of any malignancy includes radiation therapy or chemotherapy, both approaches that target rapidly dividing tumour cells. Febrile neutropenia is a common and potentially life-threatening complication in patients undergoing anti-cancer treatments. It increases the risk for infections, and in most cases also increases the severity of a given infection. The purpose of this study was to identify, and gap analyse available guidelines both local and foreign, for the management of febrile neutropenia, and to examine the practice in the local scenario. An electronic search strategy was developed to examine databases for guidelines in the management of febrile neutropenia. Pro Quest Central, MEDLINE, MEDLINE Complete, Web of Science and Cochrane databases were accessed through the University of Malta portal, Hy-di. An advanced search in Google Scholar was also performed. The reference lists of included guidelines were in turn screened for relevance, and articles identified were included in the study. Collected guidelines were then compared. The protocol which is used locally was obtained and compared against protocols identified in the systematic search. The local practice was gap analysed against the local protocol through a 6 month long retrospective audit focusing on occurrence of fever and neutropenia, risk stratification and use of empiric antibiotics. The audit was carried out at Rainbow Ward, Mater Dei Hospital. Eight guidelines pertaining to the management of febrile neutropaenia were identified. A consensus definition of fever and neutropenia was not observed. Risk stratification was recommended by all guidelines. Empiric antibiotic recommendations were also comparable and so was ‘time to antibiotics’ i.e., time period between presentation of fever and initiation of antimicrobial pharmacotherapy. Eight febrile neutropaenia episodes were recorded in three different patients during the audit period chosen. Results confirm respective practice at Mater Dei Hospital is in accordance with local guideline.