Children with cancer need fewer antibiotics

Children with cancer often receive chemotherapy, which reduces their immune response against infections. Developing a high temperature during chemotherapy may indicate the presence of a bacterial infection. The standard procedure in such cases is to admit the child to the hospital for antibiotic treatment. Later examination shows that many of these children did not have a bacterial infection. Karin Miedema studied a new risk model that will help to stop antibiotics being prescribed unnecessarily to children with cancer. Miedema is a researcher at the UMCG and is in training to become a Paediatrician. She will be awarded a PhD by the University of Groningen on 26 November 2012 for the results of her research.

There are many reasons why young cancer patients undergoing chemotherapy develop a high temperature. Only 20 to 30% of them have a bacterial infection. As such bacterial infections can develop very seriously, antibiotics are required. Other possible causes of fever include a viral infection, a reaction to chemotherapy or a blood transfusion, or damage to the lining of the intestines. Antibiotics are unnecessary in these latter cases.

Interleukine-8

Children being treated with chemotherapy who develop a high temperature are told to report to hospital as soon as possible. If they have a bacterial infection, it is vital that they are given antibiotics right away. Bacterial infections are identified by measuring the level of IL-8 in the blood, because this protein is rapidly produced by many cells in response to a bacterial infection. The new risk model being studied by Miedema entails measuring the level of IL-8 in the blood as soon as the child arrives at the hospital. The results of this test, combined with an examination of other symptoms, will determine the chance of a bacterial infection and therefore whether the child should be given antibiotics or not.

Risk model

Miedema tested the risk model on children with cancer being treated at the UMCG, VUMC, Erasmus MC, LUMC, AMC and the Isala Clinics. More than 40% of these children experienced the benefits of the risk model; they spent a shorter time in hospital and/or needed fewer or no antibiotics.

Implementation

‘The risk model is safe and ready to be implemented in the Netherlands,’ says Miedema. ‘We are now consulting with paediatric oncologists.’ Implementing this new procedure will reduce unnecessary treatment for young cancer patients, means a shorter stay in hospital, more time at home and all in all, a better quality of life. In addition, the model saves money and is helping to combat antibiotic resistance.

Curriculum Vitae

Karin Miedema (Leeuwarden, 1983) studied Medicine at the University of Groningen and conducted her PhD research at the Paediatric Oncology/Haematology Department of the Beatrix Children’s Hospital at the UMCG. Miedema will start the Paediatrics programme in the UMCG in 2013. Her thesis is entitled ‘Infections in pediatric cancer patients – cause and consequence.’