Low-risk Fever and Neutropenia in Children With Cancer: Safety and Efficacy of Oral Antibiotics in an Outpatient Setting

Inclusion Criteria: * Chemotherapy because of malignancy * Severe neutropenia (absolute neutrophil count ≤ 0.5x10E9/L) * Fever (axillary temperature ≥ 38.5°C once or ≥ 38.0°C during ≥ 2 hours) * Able to swallow oral medication * Written informed consent from patients and/or parents Exclusion Criteria: * Status post myeloablative chemotherapy * Diagnosis: acute myeloid leukemia, B-cell acute lymphoblastic leukemia, or B-cell Non-Hodgkin lymphoma * Bone marrow involvement by malignancy ≥ 25% * Any comorbidity requiring hospitalization: \[1\] mean arterial blood pressure \< 50 mmHg (up to 10 years) / \< 60 mmHg (older than 10 years); \[2\] oxygen saturation \< 94% at room air; \[3\] radiologically defined pneumonia; \[4\] focal bacterial infection; \[5\] blood cultures taken at presentation reported positive at reassessment; \[6\] need for inpatient treatment or observation due to any other reason, as judged by the physician in charge * Ever shaking chills * Ever axillary temperature ≥ 39.5°C * Antibacterial treatment before presentation with fever and neutropenia (except for prevention against Pneumocystis jiroveci \[formerly P. carinii\] pneumonia) * Modification or de novo institution of a prophylaxis against P. jiroveci pneumonia * Modification or de novo institution of a therapy with G-CSF or GM-CSF. * Allergy to ciprofloxacin and/or amoxicillin * Serum creatinine level above the upper limit of normal range