Stoppage of antibiotics at clinical improvement in pediatric cancer patients with high risk febrile neutropenia â?? A randomized clinical study

INTERVENTION: Intervention1: ARM A: Empirical antibiotic therapy discontinuation will occur when the patient is afebrile, with resolution of signs, symptoms and test abnormalities and normalization of vital signs for â?Â¥ 72 h without recovery of neutrophil 500/mm3 Antibiotics are given in standard doses and route as per recommendations Control Intervention1: ARM B: Empirical antibiotic therapy discontinuation will occur when the neutrophil count is above 500/mm3 and the patient is afebrile, with resolution of signs, symptoms and test abnormalities and normalization of vital signs for â?Â¥ 72 h. Antibiotics are given in standard doses and route as per recommendations CONDITION: Leukemia, unspecified PRIMARY OUTCOME: Recurrent feverTimepoint: daily until 35 days of start of chemotherapy SECONDARY OUTCOME: Adverse events (Nausea, vomiting)Timepoint: Daily until day 35 from start of chemotherapy Antibiotic durationTimepoint: Until Day 35 of start of chemotherapy MortalityTimepoint: Until Day 35 of start of chemotherapy Procalcitonin levelTimepoint: At onset of fever ; At stoppage of antibiotics ; At neutrophils 500/mm3 ; At Recurrance of fever Re‐admission rate ; Timepoint: Until Day 35 of start of chemotherapy Renal dysfunctionTimepoint: Alternate day until day 35 of start of chemotherapy Requirement of third line antibiotics and therapeutic anti‐fungalTimepoint: Until Day 35 of start of chemotherapy INCLUSION CRITERIA: 1. Age 2‐18 years 2. AML and ALL Induction and re‐induction with febrile neutropenia 3. Blood culture taken prior or within 24 hrs of start of anti‐microbial therapy 4. Giving consent