***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: PURPOSE To prospect ively derive and vali date a clinical prediction rule to allow a more tailored approach to the management of pediatric oncology out patients presenting with fever and neutropenia . PATIENTS AND METHODS The clinical prediction rule was derived over a 1-year period and then vali date d over the following 8 months in a new set of fever and neutropenia episodes . Patients were excluded if they presented with comorbidity or an abnormal chest x-ray ( CXR ) . RESULTS Significant bacterial infection ( SBI ; defined as any blood or urine culture positive for bacteria , interstitial or lobar consolidation on CXR , or unexpected death from infection ) was documented in 43 of the 227 episodes . Multivariate analysis found four significant factors : bone marrow disease , general appearance unwell on initial examination , monocyte count less than 0.1 x 10(9)/L , and peak oral or oral equivalent temperature greater than 39 degrees C. Only the monocyte count contributed to determining a low-risk group , excluding SBI with 84 % sensitivity ( 95 % confidence interval [ CI ] , 61 % to 100 % ) , 42 % specificity ( 95 % CI , 38 % to 46 % ) , and a negative predictive value of 92 % ( 95 % CI , 76 % to 100 % ) . If the monocyte count was > /= 0.1 x 10(9)/L at the time of presentation ( low risk ) , the incidences of SBI and bacteremia were 8 % and 5 % , respectively , versus 25 % and 17 % in the high-risk group . When vali date d in a new population of 136 episodes of fever and neutropenia , the incidences of SBI and bacteremia in the low-risk group were 12 % and 5 % , respectively , and 25 % and 19 % in the high-risk group . CONCLUSION Pediatric oncology out patients with fever and neutropenia who present with an initial monocyte count of > /= 0.1 x 10(9)/L and do not have comorbidity or an abnormal CXR at the time of presentation are at lower risk for SBI and can be considered for less aggressive initial therapy PURPOSE We sought to identify factors assessable at the time of admission for fever and neutropenia that predict bacteremia in children with cancer . PATIENTS AND METHODS One hundred fifteen consecutive episodes of fever and absolute neutrophil count ( ANC ) less than 500/microliter in 72 children with cancer were studied prospect ively to determine the risk of bacteremia using data assessable at the time of presentation . After exploratory analysis identified admission temperature and absolute monocyte count ( AMoC ) as the strongest predictive factors , recursive partitioning was used to determine cutpoints for these variables that result ed in discrimination between episodes associated with a lower or higher risk of bacteremia . RESULTS There were 24 episodes of bacteremia ( 21 % of episodes ) . Episodes were grouped using the cutpoints for AMoC and temperature : 17 % were classified as low risk for bacteremia ( AMoC > or = 100/microliter ) , 65 % as intermediate risk ( AMoC < 100/microliter and temperature < 39.0 degrees C ) , and 18 % as high risk ( AMoC < 100/microliter and temperature > or = 39.0 degrees C ) . No episodes classified as low risk were associated with bacteremia ; 19 % of intermediate-risk and 48 % of high-risk episodes were associated with bacteremia . The odds ratio of bacteremia for the high-risk versus the intermediate-risk group is 4.4 ( 95 % confidence interval , 1.6 to 12.9 ) . The risk classification was vali date d using data from 57 different episodes of fever and neutropenia treated in the same hospital . CONCLUSION Three levels of risk for bacteremia are defined using the AMoC and temperature at the time of admission for fever and neutropenia . Trials now should be conducted to test whether these factors may be used to assign some children to less intensive or outpatient  antibiotic therapy at the time of presentation with fever and neutropenia Aminoglycoside-containing combination therapy has been the st and ard empirical approach for febrile neutropenic cancer patients . With the advent of the broad-spectrum oral fluoroquinolones , it is now possible to evaluate an initial empirical alternative therapy . A prospect i ve r and omized study was conducted comparing oral ciprofloxacin plus penicillin V ( group A ) with amikacin plus carbenicillin or ceftazidime ( group B ) . Main criteria for eligibility were febrile patients with solid tumor or nonlymphoblastic lymphoma , a Zubrod PS equal to 1 or 2 , no diarrhea , mucositis , or long-term central venous catheter . A total of 108 consecutive neutropenic febrile episodes were r and omized ( 5 exclusions ) ; 55 episodes were assigned to group A and 48 to group B. Most febrile episodes were of unknown origin . There were 10 microbiologically documented episodes with two cases of bacteremia . Both regimens were well tolerated . Oral regimen was substantially cheaper than parenteral regimen . Treatment success without regimen modification was 94.5 % for group A and 93.8 % for group B ( p = .86 ; CI −0.08–0.10 ) . Oral therapy with ciprofloxacin and penicillin V  is a safe alternative to st and ard parenteral therapy in this low-risk group of neutropenic patients , with un question able cost containment To determine whether cancer patients with fever and neutropenia differ in their medical stability , 261 medical records of 184 cancer patients who were hospitalized with fever and neutropenia and treated with conventional antibiotic therapy  were studied to determine whether their presenting clinical characteristics influenced the likelihood of subsequent clinical events thought to require urgent medical attention . Overall , serious medical complications , including those without an obvious relationship to infection , occurred in 56 patient courses ( 21 % ) . We distinguished three clinical ly determined subgroups of our study population at significantly higher risk than the remaining patient group , which seemed to be at low risk . Major complications occurred in 34 ( 34 % ) of 101 in patients , 12 ( 55 % ) of 22 out patients with concurrent comorbidity requiring inpatient care , and eight ( 31 % ) of 26 out patients without concurrent comorbidity requiring inpatient care but with uncontrolled cancer . However , the remaining patients , who presented as out patients without significant comorbidity or uncontrolled cancer , had major complications in only 2 % of 112 hospitalizations . These results suggest that it may be possible to assess the medical stability of patients with fever and neutropenia  based on presenting clinical features . If confirmed prospect ively , these results may enable clinicians to identify groups of medically stable patients for whom conventional supportive care , including appropriately administered antibiotics , may be given safely under medical supervision of less intensity or of shorter duration than conventional treatment in the acute-care hospital setting 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 In a multicenter , r and omized clinical trial , the efficacy of ciprofloxacin plus azlocillin was compared with that of a st and ard regimen of ceftazidime plus amikacin for the initial empiric treatment of fever in neutropenic cancer patients . In addition , the efficacy of early conversion from intravenous therapy to orally administered ciprofloxacin was compared with that of continued ceftazidime plus amikacin . Seventy-one oncology patients with 79 episodes of fever and neutropenia were r and omly assigned to receive initial empiric antibiotic therapy with either intravenously administered ciprofloxacin and azlocillin followed by orally administered ciprofloxacin ( regimen 1 , 25 episodes ) ; ceftazidime and amikacin ( regimen 2 , 30 episodes ) ; or ceftazidime and amikacin followed by oral ciprofloxacin ( regimen 3 , 24 episodes ) . Microbiologically documented infections were the cause of fever in 10 ( 40 percent ) , seven ( 23 percent ) , and nine ( 38 percent ) episodes in regimens 1 , 2 , and 3 , respectively , including six , five , and four episodes of bacteremia . Patient survival was 90 to 92 percent in each regimen ; however , some modification of antimicrobial therapy occurred in 65 , 44 , and 41 percent of surviving patients in regimens 1 , 2 , and 3 , respectively . The rate of clearance of initial bacteremia was 67 percent ( four of six ) in regimen 1 , 100 percent ( five of five ) in regimen 2 and 50 percent ( two of four ) in regimen 3 . Patients in regimens 1 and 3 were able to convert to orally administered ciprofloxacin in 32 ( 65 percent ) of 49 episodes after a mean of six days of intravenous therapy . Superinfections occurred in 24 , 10 , and 12 percent of patients receiving regimens 1 , 2 , and 3 , respectively , and occurred similarly for patients receiving orally administered ciprofloxacin , 12 percent ( four of 32 ) , and intravenous therapy , 17 percent ( eight of 47 ) . Parenteral ciprofloxacin was generally well tolerated . One ( 4 percent ) of 25 patients receiving regimen 1 experienced oto- or nephrotoxicity , compared with eight ( 15 percent ) of 54 patients receiving regimens 1 , 2 , and 3 ( p = 0.15 ) , including three patients who required premature termination of aminoglycoside therapy . Our data suggest that the combination of ciprofloxacin and azlocillin is an effective alternative to ceftazidime and amikacin for the initial empiric therapy of febrile neutropenic patients , is generally well tolerated , and avoids the oto- and nephrotoxicity associated with aminoglycoside use . In addition , a majority of patients could change to orally administered ciprofloxacin alone after six days of parenteral therapy 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 Background . St and ard treatment for fever during periods of chemotherapy‐induced neutropenia includes hospitalization and administration of intravenous antibiotics until the patient is afebrile and no longer neutropenic . This study prospect ively evaluates the safety and cost‐effectiveness of early discharge of selected low risk children before recovery from neutropenia 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 
    Output:
    
No significant heterogeneity was shown for the primary outcomes .
This effect was stable in a wide range of patients .
Quinolones alone or combined with other antibiotics were used with comparable results .
Adverse reactions , mostly gastrointestinal , were more common with oral antibiotics .
Oral antibiotics may be safely offered to neutropenic patients with fever who are at low risk for mortality