Time to Antibiotic Administration in Pediatric Oncology Patients Presenting to The Emergency Department with Fever and Neutropenia


  • Hira Faheem Fellowship in peads heamoncology, Indus hospital Karachi
  • Sana Naveed Fellowship in Peads Heamoncology Indus hospital Karachi
  • Muhammad Shamvil Ashraf Fellowship in peads heamoncology, affiliated form Indus Hospital
  • Muhammad Rafi Senior consultant pediatric oncology
  • Ghulam Qadir Pathan


Febrile neutropenia, TTA


Objective: To evaluate the time to antibiotic administration (TTA) in febrile neutropenia patients, and their outcomes.

Methodology: Descriptive cross-sectional cohort Study was conducted at The Indus Hospital and Health Network in Karachi, Pakistan from April 2021 to September 2021. All the children with fever and neutropenia secondary to malignancy or oncologic treatment and those who gave consent to being part of the study were included. Clinical measures and laboratory examinations were documented. Patient records was accessed through the Hospital Management Information System to identify pediatric oncology patients presenting to the ED with fever and neutropenia (antibiotic given on clinical assessment and then neutropenia confirmed on laboratory testing). The following information were obtained for every participant: hematologic/ oncologic diagnosis, absolute neutrophil count (ANC), patient triage time, time to antibiotic order by doctor, (TTA), any barrier to TTA if given 60 minutes after triage, patient outcome 24 hours after TTA. Physician and nursing notes were reviewed to identify potential causes of delay in antibiotic administration. Data was analyzed using SPSS version 26.

Results: A total of 357 patients were studied, their mean age was 7.40+4.13 years. Males were in majority 66.7%.  Sever neutropenia was in 41.2% of the cases. Overalled of the patients and patients related barrier were most common. 71.40% cases given antibiotics within 60 minutes, while 28.60% were given after 60 minutes. Out of all 9.0% were discharged, 48.7% were followed in daycare, 29.4% were admitted in ward, 8.7% were admitted DHU, 4.2% were admitted in ICU and 2.2% cases were died. Outcomes of the patients were statistically insignificant according to time to antibiotic given after triage (p=>0.05), while ICU admission was significantly high among patients those were given antibiotic within 60 minutes (p=0.012).

Conclusion: The administration of antibiotics in pediatric oncology patients does not seem to have a significant impact on delaying the initiation. Current evidence suggests that such delays are minimal and do not have a significant impact on patient outcomes. Therefore, the use of antibiotics in pediatric oncology patients should continue to be based on clinical judgment and individual patient needs, rather than concerns about delaying initiation.






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