TY - JOUR T1 - PAnTher Cub: procalcitonin-guided antibiotic therapy for febrile neutropenia in children and young people with cancer - a single-arm pilot study JF - BMJ Paediatrics Open JO - BMJ Paediatrics Open DO - 10.1136/bmjpo-2021-001339 VL - 6 IS - 1 SP - e001339 AU - Jessica Elizabeth Morgan AU - Bob Phillips Y1 - 2022/03/01 UR - http://bmjpaedsopen.bmj.com/content/6/1/e001339.abstract N2 - Background Febrile neutropenia (FN) is a common complication of cancer treatment in children and young people, and many episodes are over-treated. Procalcitonin, may be an appropriate tool to guide the stopping of antibiotics in those at low risk of serious bacterial infection. Supportive care trials in this population have proven to be difficult to undertake. This single-arm pilot study aimed to evaluate whether a study using a procalcitonin-guided stopping-rule for antibiotics in paediatric FN is possible.Methods Daily procalcitonin levels were performed during episodes of FN and clear guidance given for antibiotic discontinuation. Episode data and quantitative feasibility data were collected alongside interviews with professionals and ethnographic observations. Analysis was descriptive.Results Of 32 patients and families approached, 28 patients consented, and 13 had febrile neutropenia. In total, 16 episodes were included in the study. All relevant FN episodes had data captured, with adequate data collection. There were no significant safety events. In 4/8 (50%) of episodes without clear microbiologically documented or clinical infection, antibiotics were reduced in duration or in spectrum. Interviews with professionals revealed the importance of the research, the value of key individuals in the study team, particular challenges of this protocol and suggestions for study improvements.Conclusions Studies to evaluate procalcitonin-guided approaches to stopping antibiotics in paediatric FN are possible.Data are available upon reasonable request. The data for this study contains the following elements, which when combined would make the patients identifiable given the rarity of childhood cancer in the identified geographical area and time of this study: # Demographic data: (ii) episode date; (iii) age; (iv) cancer diagnosis & treatment;# FN episode data: (i) inpatient or outpatient onset; (ii) time of start of temperature; (iii) time of presentation;A reduced data-set taking out all items to produce sufficient anonymity (for sensitive data; childhood cancer) would severely limit their utility for researchers.The patients and families who took part in this study, and the Research Ethics Committee who granted permission for it, agreed the data should be available for sharing in ethically approved secondary use projects. Such studies are typically individual participant data meta-analysis collaboratives. Anyone who has such an approved project, investigating aspects of paediatric febrile neutropenia and biomarker profiles, is encouraged to approach bob.phillips@york.ac.uk <mailto:bob.phillips@york.ac.uk> for access to the data set. ER -