Supplementary file 1_Early discontinuation vs. continuation of empirical antibiotics in patients with cancer and febrile neutropenia: a systematic review and meta-analysis of randomized controlled trials.docx

Co-primary outcomes were days of antibiotic therapy and all-cause mortality. The review was registered in PROSPERO (CRD420261434782).</p>Results<p>Fifteen trials involving 1,692 participants (1,679 contributing to the mortality analysis) were included. Early discontinuation reduced antibiotic exposure by a mean of 3.43 days (95% CI − 5.59 to −1.27; I² = 87.1%), with a larger reduction in children (−5.04 days, 95% CI − 8.55 to −1.54) than adults (−1.52 days, 95% CI − 3.49 to 0.44; subgroup p = 0.0002).

All-cause mortality did not differ between groups (Peto odds ratio 1.23, 95% CI 0.64 to 2.36), and the absolute risk difference across all trials was null (0.00, 95% CI − 0.01 to 0.01; I² = 0%). No significant differences were observed in new bloodstream infections, treatment failures, or fever recurrences.</p>Conclusion<p>In clinically stable, afebrile patients with cancer-related febrile neutropenia, early antibiotic discontinuation shortened antibiotic exposure, particularly in children, without a detectable increase in mortality or major infectious complications.

Larger adult trials are needed to confirm safety.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/view/CRD420261434782, CRD420261434782.</p>