***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Recent reports and previous r and omized trials conducted at the authors ' institution suggested that children with lower risk febrile neutropenic ( LRFN ) may benefit from substitution of oral antibiotic therapy for parenteral therapy . The objective of this study was to determine the efficacy of parenteral‐oral outpatient therapy in the management of children with LRFN who were receiving treatment for malignant disease PURPOSE To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection ( IBI ) . PATIENTS AND METHODS Children presenting with febrile neutropenia at six hospitals in Santiago , Chile , were categorized as high or low risk for IBI . Low-risk children were r and omly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution . Outcome and cost were determined for each episode and compared between both groups using predefined definitions and question naires . RESULTS A total of 161 ( 41 % ) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk , of which 149 were r and omly assigned to ambulatory ( n = 78 ) or hospital-based ( n = 71 ) treatment . In both groups , mean age ( ambulatory management , 55 months ; hospital-based management , 66 months ) , sex , and type of cancer were similar . Outcome was favorable in 74 ( 95 % ) of 78 ambulatory-treated children and 67 ( 94 % ) of 71 hospital-treated children ( P = NS ) . Mean cost of an episode was US 638 dollars ( 95 % CI , 572 dollars to 703 dollars ) and US 903 dollars ( 95 % CI , 781 dollars to 1,025 dollars ) for the ambulatory and hospital-based groups , respectively ( P = .003 ) . CONCLUSION For children with febrile neutropenia at low risk for IBI , ambulatory management is safe and significantly cost saving compared with st and ard hospitalized therapy Prompt treatment with empirical antibiotics in neutropenic febrile patients reduces morbidity and mortality . Most patients have been treated with parenteral combination antibiotics , but newer antibiotics with broad-spectrum bactericidal activity have made monotherapy feasible . Ofloxacin , a broad-spectrum fluoroquinolone , has the additional advantage that bactericidal concentrations can be achieved with oral administration . We have compared ofloxacin as an oral single agent with st and ard parenteral combination antibiotics for the management of neutropenic febrile patients in a prospect i ve , r and omised trial . Patients with severe neutropenia ( absolute neutrophil count less than or equal to 0.5 x 10(9)/l ) , fever above 38 degrees C , and ability to take drugs by mouth were eligible for the study . After initial investigations , 60 patients were r and omly assigned to oral  ofloxacin 400 mg twice daily and 62 to parenteral combination antibiotic therapy ( amikacin 15 mg/kg daily , plus , at various times in the trial , carbenicillin , cloxacillin , or piperacillin ) . Patients were examined 72 h and 7 days after the start of treatment and when neutropenia resolved . 24 ( 40 % ) ofloxacin-treated and 26 ( 42 % ) combination-treated patients had pyrexia of unknown origin ( PUO ) . In both treatment groups , the treatment success rate was higher for such patients than for those with clinical ly or microbiologically documented infections ( 92 % vs 67 % [ p less than 0.05 ] for ofloxacin ; 85 % vs 64 % for combination ) . There were no significant differences in success rates of ofloxacin  and combination  treatment for these subgroups or overall ( 77 % vs 73 % ) . Patients with neutropenia for less than 1 week had better responses to both treatments than patients with longer-lasting neutropenia . There were 4 ( 7 % ) deaths in the ofloxacin group and 6 ( 10 % ) in the combination group . Both regimens were well tolerated . We conclude that oral single-agent ofloxacin is as effective as parenteral combination antibiotic therapy in neutropenic febrile patients , especially those expected to have short duration s of neutropenia Background . Hospitalization and intravenous ( IV ) broad‐spectrum antibiotics are the st and ard of care for all febrile neutropenic patients with cancer . Recent work suggests that a low‐risk population exists who might benefit from an alternate approach Neutropenic sepsis remains a potentially life-threatening complication of anticancer chemotherapy . However , it is possible to identify patients who are at low risk for serious complications and for whom less-intensive , more-convenient treatment may be appropriate . The aim of this study was to assess the efficacy and safety of oral antibiotics in conjunction with early hospital discharge in comparison with st and ard in-patient intravenous antibiotics in patients with low-risk neutropenic fever . In all , 126 episodes of low-risk neutropenic fever occurred in 102 patients . Patients were r and omised to receive either : an oral regimen of ciprofloxacin ( 750 mg 12 hourly ) plus amoxicillin – clavulanate ( 675 mg 8 hourly ) for a total of 5 days , or a st and ard intravenous regimen of gentamicin and tazocin ( piperacillin/tazobactam ) until hospital discharge . Patients r and omised to oral antibiotics were eligible for discharge following 24 h of hospitalisation , if clinical ly stable and symptomatically improved . The efficacy of the two arms was similar : initial treatment was successful without antibiotic modification in 90 % of episodes in the intravenous arm and 84.8 % of episodes in the oral arm , P=0.55 , absolute difference between the groups 5.2 % ; 95 % confidence interval ( CI ) for the difference −7 to 17.3 % . Only one episode in the oral arm was associated with significant clinical deterioration : this occurred within the initial in-patient assessment period . The median in-patient stay was 4 days in the intravenous arm ( range 2–8 ) and 2 days in the oral arm ( range 1–16 days ) , P<0.0005 . The reduction in hospital stay led to significant cost-savings in the oral arm . In conclusion , this study suggests that oral antibiotics in conjunction with early hospital discharge for patients who remain stable after a 24 h period of in-patient monitoring offers a feasible and cost-effective alternative to conventional management of low-risk neutropenic fever Goals of work Patients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer ( MASCC ) score might benefit from ambulatory treatment . Optimal management remains to be clearly defined , and new oral antibiotics need to be evaluated in this setting . Material s and methods Cancer patients with febrile neutropenia and a favorable MASCC score were r and omized between  oral moxifloxacin and intravenous ceftriaxone .  All were fit for early hospital discharge . The global success rate was related to the efficacy of monotherapy , as well as to the success of ambulatory monitoring . Main results The trial was closed prematurely because of low accrual . Ninety-six patients were included ( 47 in the ceftriaxone arm and 49 in the moxifloxacin arm ) . A total of 65 % were women , 30.2 % had lymphoma , 34.4 % had metastatic , and 35.4 % had non-metastatic solid tumors . The success rates of home antibiotics were 73.9 % and 79.2 % for ceftriaxone and moxifloxacin , respectively . Seven patients were not discharged , and 14 required re-hospitalization . There were 17 % of microbiologically documented infections that were , in most cases , susceptible to oral monotherapy . Conclusions These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever PURPOSE Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy , but some patients are at low risk for serious medical complications . The purpose of this study was to develop an internationally vali date d scoring system to identify these patients . MATERIAL S AND METHODS Febrile neutropenic cancer patients were observed in a prospect i ve multinational study . Independent factors assessable at fever onset , predicting low risk of complications , on a r and omly selected derivation set , were assigned integer weights to develop a risk-index score , which was subsequently tested on a validation set . RESULTS On the derivation set ( 756 patients ) , predictive factors were a burden of illness indicating absence of symptoms or mild symptoms ( weight , 5 ; odds ratio [ OR ] , 8.21 ; 95 % confidence interval [ CI ] , 4.15 to 16.38 ) or moderate symptoms ( weight , 3 ; OR , 3.70 ; 95 % CI , 2.18 to 6.29 ) ; absence of hypotension ( weight , 5 ; OR , 7.62 ; 95 % CI , 2.91 to 19.89 ) ; absence of chronic obstructive pulmonary disease ( weight , 4 ; OR , 5 . 35 ; 95 % CI , 1.86 to 15.46 ) ; presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies  ( weight , 4 ; OR , 5.07 ; 95 % CI , 1.97 to 12.95 ) ;  outpatient status  ( weight , 3 ; OR , 3.51 ; 95 % CI , 2.02 to 6.04 ) ; absence of dehydration ( weight , 3 ; OR , 3.81 ; 95 % CI , 1.89 to 7.73 ) ; and age less than 60 years ( weight , 2 ; OR , 2.45 ; 95 % CI , 1.51 to 4.01 ) . On the validation set , a Multinational Association for Supportive Care in Cancer risk-index score > /= 21 identified low-risk patients with a positive predictive value of 91 % , specificity of 68 % , and sensitivity of 71 % . CONCLUSION The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective Febrile neutropenia is a heterogeneous condition . Recently , several risk factors have been defined , permitting the definition of a lower risk group of patients who may benefit form less aggressive therapy . The use of an oral antibiotic approach was tested in the current trial BACKGROUND Hospitalization with single or multi-agent antibiotic therapy has been the st and ard of care for treatment of febrile neutropenia in cancer patients . We hypothesized that an empiric antibiotic regimen that is effective and that can be administered once-daily will allow for improved hospital utilization by early transition to outpatient care . PROCEDURE Febrile pediatric cancer patients with anticipated prolonged neutropenia were r and omized between a regimen of once-daily ceftriaxone plus amikacin ( C + A ) and imipenem monotherapy ( control ) . Afebrile patients on C + A satisfying " Early Discharge Criteria " at 72 hr continued treatment as out patients . We compared the outcome , adverse events , duration of hospitalization , and cost between both groups . RESULTS A prospect i ve r and omized controlled clinical trial was conducted on 129 febrile episodes in pediatric cancer patients with prolonged neutropenia . No adverse events were seen in 32 children ( 84 % of study arm ) treated on an outpatient basis . We found a statistically significant difference between the duration of hospitalization of the C + A group [ median 5 days ] and control [ median 9 days](P < 0.001 ) , per episode antibiotic cost ( P < 0.001 ) and total episode cost ( P < 0.001 ) . There was no statistically significant difference in the response to treatment at 72 hr or after necessary antimicrobial modifications . CONCLUSIONS We conclude that pediatric febrile cancer patients initially considered at risk for sepsis due to prolonged neutropenia can be re-evaluated at 72 hr for outpatient therapy . The convenience , low incidence of adverse effects , and cost benefit of the once-daily regimen of C + A may be particularly useful to reduce the overall treatment costs and duration of hospitalization BACKGROUND Intravenously administered antimicrobial agents have been the st and ard choice for the empirical management of fever in patients with cancer and granulocytopenia . If orally administered empirical therapy is as effective as intravenous therapy , it would offer advantages such as improved quality of life and lower cost . METHODS In a prospect i ve , open-label , multicenter trial , we r and omly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin ( 750 mg twice daily ) plus amoxicillin-clavulanate ( 625 mg three times daily ) or st and ard daily doses of intravenous ceftriaxone plus amikacin . All patients were hospital 
    Output:
    
Based on the current literature , outpatient treatment of FN is a safe and efficacious alternative to inpatient management .