***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: 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 A prospect i ve , r and omized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia . Patients aged 2–16 years with hematological malignancies who had febrile neutropenia were r and omly assigned to receive piperacillin/tazobactam ( 80 mg/kg piperacillin/10 mg/kg tazobactam , q6h ) combined with amikacin ( PTA ) ( 7.5 mg/kg , q12h ) or meropenem or imipenem ( 20 mg/kg , q8h ) ( C ) . Response to antimicrobial therapy , evaluated for etiological agents , was measured . Duration of fever , neutropenia , and hospitalization , mortality , and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups . Out of 87 febrile neutropenic episodes that were evaluable for comparison , 46 patients received PTA and 41 patients were treated with carbapenems ( imipenem or meropenem ) . Overall , the microbiologically documented infection rate was 21.9 % , with Staphylococcus epidermidis as the most common cause of bacteremia . The rate of treatment modification was 56.5 % in the PTA group and 53.6 % in the carbapenem group with no statistical difference ( p > . 05 ) . There was no infection-related mortality during the study period . There was no difference between the two regimens for duration s of fever , neutropenia , and hospitalization ( p > . 05 for all categories ) . PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies BACKGROUND The aim of this study was to evaluate the efficacy and safety of piperacillin/tazobactam ( PIP/TAZO ) and cefozopran ( CZOP ) monotherapy in pediatric cancer patients with febrile neutropenia ( FN ) . PROCEDURE A total of 119 febrile episodes in 49 neutropenic pediatric cancer patients ( 20 females and 29 males ) with a median age of 6.8 years ( range , 0.3 - 18.4 years ) received r and omized treatment either with PIP/TAZO 125 mg/kg every 8 hr or CZOP 25 mg/kg every 6 hr . Clinical response was determined at completion of therapy . Duration s of fever and neutropenia , the need for modification of the therapy , and mortality rates were compared between the two groups . RESULTS The frequency of success without modification of treatment was not significantly different between PIP/TAZO ( 59.6 % ) and CZOP ( 53.2 % ) . Duration s of fever and antibiotic therapy did not differ between the treatment groups , and no major side effects were observed in either group . CONCLUSIONS PIP/TAZO and CZOP monotherapy were both effective and safe for the initial empirical treatment of pediatric cancer patients with FN 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 prospect i ve , open-label , r and omized , comparative study in pediatric cancer patients was conducted to evaluate the efficacy and safety of cefepime and meropenem in the empiric therapy of febrile neutropenic patients . Febrile episodes were classified as microbiologically documented infection , clinical documented infection , or fever of unknown origin . Clinical response to therapy was classified as success or failure . In this period 37 children with solid tumors including lymphoma , 25 males , 12 females , had neutropenia on 65 occasions . Microbiologically documented infections occurred in 21 episodes ( 32.31 % ) . Frequency of positive bacteria isolated was higher than gram-negative bacteria . There was no infection-related death . There were no statistical differences between the cefepime and meropenem groups for duration of fever or neutropenia , response rate , and necessity for modification . Cefepime appears to be as effective and safe as meropenem for empiric treatment of febrile episodes in neutropenic pediatric cancer patients BACKGROUND AND PURPOSE The empirical use of antibiotic therapy is widely accepted for patients with fever and neutropenia during cancer chemotherapy . The use of intravenous monotherapy with broad-spectrum antibiotics in patients at high risk for complications is an appropriate alternative . However , few data are available for pediatric patients . The aim of this study was to compare the efficacy and safety of cefepime ( CFP ) monotherapy with ceftriaxone plus amikacin ( CFT+AK ) in children and adolescents with febrile neutropenia ( FN ) . METHODS A prospect i ve r and omized open study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy  was conducted . Patients were r and omized to receive CFP or CFT+AK . The r and omization was based on number lists . RESULTS Fifty seven patients with 125 episodes of fever and neutropenia were evaluated ( CFP , 62 episodes ; CFT+AK , 63 episodes ) . The mean neutrophil count at admission to hospital was 118.6 cells/mm(3 ) for patients in the CFP group and 107 cells/mm(3 ) for patients in the CFT+AK group . The mean duration of neutropenia was 9 days for the CFP group and 8 days for the CFT+AK group . Analysis of only the first episodes for each patient showed that CFP treatment was successful for 65.5 % of episodes and CFT+AK was successful for 64.3 % of episodes . The overall rates of success with modification were 90 % for the CFP group and 89 % for the CFT+AK group . No major treatment-emergent toxicity was reported . CONCLUSION Monotherapy with CFP seems to be as effective and safe as CFT+AK for initial empirical therapy in children and adolescents with FN 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 PURPOSE To determine if granulocyte colony-stimulating factor ( G-CSF ) with empirical antibiotics accelerates febrile neutropenia resolution compared with antibiotics without it . PATIENTS AND METHODS Eligible children were treated without prophylactic G-CSF and presented with fever ( temperature > 38.3 degrees C ) and neutropenia afterward . Patients with acute myelogenous leukemia and myelodysplastic syndrome were excluded . Assignments were r and omized between G-CSF ( 5 microg/kg/day ) or none beginning within 24 hr of antibiotics . Subcutaneous administration was recommended , but intravenous G-CSF was allowed . Patients remained on study until absolute neutrophil count ( ANC ) > 500/microl and > or = 48 hr without fever . RESULTS One of 67 patients enrolled was ineligible , 59 had acute lymphoblastic leukemia ( ALL ) . Thirty-four were assigned to antibiotics , 32 to G-CSF plus antibiotics . Adding G-CSF significantly reduced neutropenia and febrile neutropenia recovery times . Median days to febrile neutropenia resolution was nine earlier with G-CSF ( 4 vs. 13 days ) ( P < 0.0001 ) . However , there was no difference in the resolution of fever between arms . Hospitalization median was shorter by 1 day with G-CSF ( 4 vs. 5 days ) ( P = 0.04 ) . There was no difference in the duration of IV and oral antibiotic treatment , addition of antifungal therapy , and shock incidence . A trend for decreased incidence of late fever with G-CSF was noted ( 6.3 vs. 23.5 % ) ( P = 0.08 ) . CONCLUSIONS Adding G-CSF to empiric antibiotic coverage accelerates chemotherapy-induced febrile neutropenia resolution by 9 days in pediatric patients , mainly with ALL , which results in a small but significant difference in the median length of hospitalization The purpose of this study is to compare the efficacy and safety of piperacillin/tazobactam ( PIP/TAZO ) versus PIP/TAZO plus amikacin in febrile neutropenic children with acute leukemia ( AL ) . Children with AL who had febrile neutropenic episodes were r and omized to treatment with PIP/TAZO versus PIP/TAZO plus amikacin . Modification was defined as addition of other antimicrobials and /or antifungal agents to the empirical therapy . Protocol failure was defined as withdrawal of the empirical regimen and introduction of other antimicrobials due to failure in controlling infection . Seventy-two febrile episodes of 42 patients with a median age of 4.5 years ( 3.5 months to 19 years ) were evaluated . There were 37 and 35 episodes in PIP/TAZO and combination arms , respectively . Success without modification , with modification , protocol failure , duration of treatment were 45.9 % , 35.1 % , 18.9 % , and 10 days in PIP/TAZO arm and 42.9 % , 37.1 % , 20 % , and 12 days in combination arm , respectively ( P > .05 ) . There was no significant difference between the empirical therapy arms regarding median duration of neutropenia and defervescence of fever . Empirical therapy was substituted by other drugs in 6 and 5 episodes in PIP/TAZO and combination arms , respectively . There was no infection-related death . There was reversible increase in serum creatinine in 1 episode on the combination arm . Monotherapy with PIP/TAZO was effective and safe for initial empirical treatment of febrile neutropenic episodes in children with AL . However , local bacterial resistance patterns should be considered in daily practice 
    Output:
    
Antipseudomonal penicillin and fourth-generation cephalosporin monotherapy were associated with similar failure and mortality rates .
Outpatient management and oral antibiotics were safe in low-risk FN with no infection-related mortality observed in any patient and no significant differences in outcomes compared with inpatient management and intravenous therapy .
Monotherapy for high-risk FN and outpatient and oral management for low-risk FN are effective strategies .