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Abstract

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