Study to Reduce Duration of Antibiotic Therapy in Haematological Patients With Fever and Neutropenia (HOWLONG)

• Crude mortality [ Time Frame: 28 days following the initiation of empiric antibiotic treatment. ] [ Designated as safety issue: Yes ]
• Number of days of fever [ Time Frame: 28 days following the initiation of empiric antibiotic treatment ] [ Designated as safety issue: Yes ]

Clinical trial intended to reduce the antibiotic therapy duration in "in-hospital" patients with haematological diseases who develop fever and low white blood cell count (neutropenia).

The optimal duration of the empirical antimicrobial therapy (AT) in hematological patients with febrile neutropenia (FN) is unknown. The Infectious Diseases Society of America (IDSA) recommends maintaining AT at least until the neutropenia is recovered, because literally "years of experience have proven this approach to be safe and effective". This recommendation is likely to cause unnecessarily prolonged treatments, and is against the urgent need of optimizing the antimicrobial therapy proposed by IDSA. The main objective of this study is to establish whether an individualized clinical protocol is better than the standard criteria (recovery of neutropenia as the criterion to suspend the empirical AT in hematological patients with FN).

• Other: Empirical antimicrobial treatment discontinuation
  Empirical antimicrobial treatment discontinuation will occur when the patient is: Afebrile, with resolution of signs, symptoms and test abnormalities secondary to complementary source of infection and with normalization of vital signs for ≥ 72 h.
• Other: Standard empirical antimicrobial treatment discontinuation

  The empirical antimicrobial treatment discontinuation will occur when the patient is:

  The neutrophil count is above 500 million per mm3.

• Experimental: Experimental Arm
  an individualized clinical protocol as the criterion to suspend the empirical antimicrobial therapy
  Intervention: Other: Empirical antimicrobial treatment discontinuation
• Active Comparator: Control Arm
  the recovery of neutropenia (standard) as the criterion to suspend the empirical antimicrobian therapy.
  Intervention: Other: Standard empirical antimicrobial treatment discontinuation

Inclusion Criteria:

• Adult patients (equal or older than 18 years) of both sexes admitted in the Department of Clinical Hematology who develop a febrile neutropenia. Including fever with unknown source and fever secondary to infection focus of clinical diagnosis without laboratory confirmation.
• Informed consent signed.

Exclusion Criteria:

• Fever with etiologic diagnosis.
• Patients with epilepsy.
• Pregnant or lactating women.
• Patients with HIV infection.
• Patients with severe renal failure.
• Patients who have received allogeneic hematopoietic cell transplantation.