***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / Aims : There exists few pediatric data on the safety and efficacy of prophylactic antibiotics during chemotherapy-induced agranulocytosis . Methods : We prospect ively studied the incidence of infection-related fever in 38 children , aged 2 - 16 years , with acute myeloid leukemia ( AML ) over 121 chemotherapy treatment cycles . A prophylactic group ( n = 18 ) was given either vancomycin/cefepime ( 400 mg/m2 , q12 h/50 mg/kg , q12 h ) or piperacillin/tazobactam ( 110 mg/kg , q12 h ) . Control patients ( n = 20 ) received no preventive antibiotics . Results : The prophylactic group ( 59 treatment cycles ) experienced fever less frequently than the control group ( 0.4 vs. 0.9 events ; p < 0.001 ) , had a longer interval between agranulocytosis and fever ( 6.4 vs. 3.8 days ; p = 0.007 ) , had a shorter duration of hospitalization ( 21.5 vs. 28.5 days ; p < 0.001 ) , and had a lower rate of lung infection ( 38.8 vs. 80.0 % ; p < 0.001 ) . One patient taking vancomycin experienced a skin rash and 3 patients taking piperacillin/tazobactam had diarrhea ; these side effects subsided after antibiotics were discontinued . Conclusions : In children with AML , prophylactic antibiotics during the period of chemotherapy-induced agranulocytosis can effectively reduce the incidence of infectious fever and can shorten the average length of hospital stay , improving treatment success and quality of life PURPOSE To develop a score predicting the risk of adverse events ( AEs ) in pediatric patients with cancer who experience fever and neutropenia ( FN ) and to evaluate its performance . PATIENTS AND METHODS Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy  were observed in a prospect i ve multicenter study . A score predicting the risk of future AEs ( ie , serious medical complication , microbiologically defined infection , radiologically confirmed pneumonia ) was developed from a multivariate mixed logistic regression model . Its cross-vali date d predictive performance was compared with that of published risk prediction rules . Results An AE was reported in 122 ( 29 % ) of 423 FN episodes . In 57 episodes ( 13 % ) , the first AE was known only after re assessment after 8 to 24 hours of inpatient management . Predicting AE at re assessment was better than prediction at presentation with FN . A differential leukocyte count did not increase the predictive performance . The score predicting future AE in 358 episodes without known AE at re assessment used the following four variables : preceding chemotherapy more intensive than acute lymphoblastic leukemia maintenance ( weight = 4 ) , hemoglobin > or = 90 g/L ( weight = 5 ) , leukocyte count less than 0.3 G/L ( weight = 3 ) , and platelet count less than 50 G/L ( weight = 3 ) . A score ( sum of weights ) > or = 9 predicted future AEs . The cross-vali date d performance of this score exceeded the performance of published risk prediction rules . At an overall sensitivity of 92 % , 35 % of the episodes were classified as low risk , with a specificity of 45 % and a negative predictive value of 93 % . CONCLUSION This score , based on four routinely accessible characteristics , accurately identifies pediatric patients with cancer with FN at risk for AEs after re assessment 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 A risk prediction model for invasive bacterial infection ( IBI ) was prospect ively evaluated among children presenting with cancer , fever , and neutropenia . The model incorporated assessment of 5 previously identified risk factors : serum level of C-reactive protein ( CRP ) > /=90 mg/L , hypotension , identification of relapse of leukemia as the cancer type , platelet count of < /=50,000 platelets/mm(3 ) , and recent receipt of chemotherapy  [ 16 ] . Children were uniformly evaluated at enrollment and were classified as having high or low risk for IBI according to a model that considers the number and type of variables present . Of the 263 febrile episodes evaluated during a 17-month period , 140 ( 53 % ) were in IBI-positive children . The sensitivity , specificity , and positive and negative predictive values of the model were 92 % , 76 % , 82 % , and 90 % , respectively . Identification of these 5 risk factors during the first 24 h of hospitalization was helpful in discriminating between children with a high or low risk for IBI BACKGROUND Febrile neutropenia ( FN ) is a frequent , serious complication of intensive pediatric chemotherapy regimens . The aim of this trial was to compare quality of life ( QOL ) between inpatient and outpatient intravenous antibiotic management of children and adolescents with low risk febrile neutropenia ( LRFN ) . PROCEDURE In this r and omised non-blinded trial , patients between 1 and 21 years old , receiving low/moderate intensity chemotherapy were pre-consented and , on presentation to emergency ( ED ) with FN satisfying low risk criteria , r and omised to either outpatient or inpatient care with intravenous cefepime 50 mg/kg ( 12 hourly ) . All patients continued antibiotics for at least 48 hours , until afebrile for 24 hours and demonstrating a rising absolute neutrophil count ≥200/mm(3 ) . Several domains of QOL were examined by daily question naire . RESULTS Eighty-one patients presented to ED with 159 episodes of fever . Thirty-seven FN presentations involving 27 patients were r and omised to inpatient ( 18 ) and outpatient ( 19 ) management  . Combined QOL mean scores for parents were higher for the outpatient group and scores for three specific parent variables ( keeping up with household tasks/time spent with partner/time spent with other children ) were higher among out patients . There was no difference in parent confidence/satisfaction in care between groups . Patients scored better in the outpatient group overall and for sleep and appetite . The mean length of fever was equivalent between groups and there were no serious adverse events attributable to cefepime or outpatient care . CONCLUSION Outpatient cefepime management of LRFN provided significant benefit to parents and patients  across several QOL domains and appeared both feasible and safe During a 2-year period , all children with cancer , neutropenia , and fever who were admitted to Hospital de Niños Luis Calvo Mackenna ( Santiago , Chile ) were enrolled in a study of the safety of stopping antibiotic therapy on day 3 of treatment . Children who met predefined criteria for nonbacterial fever were r and omized on day 3 to stop ( group A ) or continue ( group B ) antibiotic therapy . A total of 220 children with cancer had 238 episodes of fever and neutropenia ; 68 children with 75 episodes met entry criteria for nonbacterial fever ( group A , 36 ; group B , 39 ) . Both groups were comparable in terms of age , gender , oncological disease , chemotherapy status , and initial neutrophil count . Resolution of symptoms occurred in 34 of 36 episodes in group A and 36 of 39 episodes in group B ( P > .05 ) . No deaths occurred , and bacterial superinfections were uncommon . For children with cancer as well as episodes of fever and neutropenia without an identifiable bacterial etiology at admission , stopping antibiotic therapy on day 3 was safe and not associated with a higher risk of bacterial superinfections 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 AIM Empirical therapy for children with febrile neutropenia has traditionally consisted of combination antibiotics , usually a beta-lactam and an aminoglycoside . However , recent trends and international guidelines have now made monotherapy a feasible option in the management of this group of patients . We prospect ively evaluated the efficacy and safety of cefepime monotherapy in our population of paediatric cancer patients with febrile neutropenia . METHODS An audit was performed on children aged 16 years and younger presenting with fever and neutropenia who were managed with empirical single-agent cefepime .  The patients were analysed for clinical outcome , documented infections and side-effects of the study drug . Success was defined as clinical improvement without treatment modification . Death or any change to the empirical antibiotic was considered as failure . RESULTS In this study 79 children ( median age 5.2 years ) with 133 episodes of febrile neutropenia were prospect ively studied between August 2004 and August 2005 . A microbiologically documented infection was seen in 26 episodes . The success rate of cefepime monotherapy was 60 % . The rate of survival through neutropenia ( with or without modification ) was 98 % . No significant adverse effects were seen . CONCLUSION Cefepime monotherapy is a safe and feasible option for treatment of childhood cancer patients with febrile neutropenia BACKGROUND The st and ard treatment of fever in chemotherapy-induced neutropenia ( FN ) includes emergency hospitalization and empirical intravenous antimicrobial therapy . This study determined if first-day step-down to oral outpatient treatment is not inferior to continued st and ard regarding safety and efficacy in children with low-risk FN . PROCEDURE In a r and omized controlled non-blinded multicenter study , pediatric patients with FN after non-myeloablative chemotherapy  were reassessed after 8 - 22 hours of inpatient intravenous antimicrobial therapy .  Low-risk patients were r and omized to first-day step-down to experimental ( outpatient , oral amoxicillin plus ciprofloxacin ) versus continued st and ard treatment .  Exact non-inferiority tests were used for safety ( no serious medical complication ; non-inferiority margin of difference , 3.5 % ) and efficacy ( resolution of infection without recurrence , no modification of antimicrobial therapy , no adverse event ; 10 % ) . RESULTS In 93 ( 26 % ) of 355 potentially eligible FN episodes low-risk criteria were fulfilled , and 62 were r and omized , 28 to experimental ( 1 lost to follow-up ) and 34 to st and ard treatment . In intention-to-treat analyses , non-inferiority was not proven for safety [ 27 of 27 ( 100 % ) vs. 33 of 34 ( 97 % ; 1 death ) episodes ; 95 % upper confidence border , 6.7 % ; P = 0.11 ] , but non-inferiority was proven for efficacy [ 23 of 27 ( 85 % ) vs. 26 of 34 ( 76 % ) episodes ; 95 % upper confidence border , 9.4 % ; P = 0.045 ] . Per- protocol analyses confirmed these results . CONCLUSIONS In children with low-risk FN , the efficacy of first-day step-down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non-inferior to continued hospitalization and intravenous antimicrobial therapy . The safety of this procedure , however , was not assessable with sufficient power 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 
    Output:
    
Evidently , there are still profound gaps regarding very early and early discharge in children with cancer and febrile neutropenia .