United States: A clinical trial has found that ending antibiotic treatment before blood count recovery could reduce unnecessary medication use among selected cancer patients with febrile neutropenia, without showing an increase in serious complications.
The preliminary findings from the END (Early Neutropenic Fever De-escalation of Antibiotics) study were presented at IDWeek 2026. The research examines whether patients with blood cancers can safely stop intravenous antibiotics earlier than currently recommended.
Patients with high-risk febrile neutropenia are generally prescribed broad-spectrum antibiotics until their bone marrow recovers if doctors cannot identify a bacterial infection. However, extended antibiotic use can increase the risk of drug-resistant infections, Clostridioides difficile infection and disruption of the body’s natural microbiome.
The Phase IV randomised trial involved adults hospitalised with high-risk febrile neutropenia at a cancer centre. Participants who remained fever-free for 48 hours without an identified bacterial source were divided into two groups: one stopped antibiotics early, while the other continued treatment until blood count recovery.
Between May 2024 and April 2026, 157 patients were enrolled, of whom 148 completed follow-up. The interim assessment recorded serious complications, including death, septic shock and intensive care admission within 60 days, in 11% of the early-treatment group and 13.3% of those receiving standard care.
Antibiotic consumption, however, was considerably lower among patients who stopped treatment early. They averaged 10.5 antibiotic-free days during neutropenia, compared with 3.8 days in the standard-treatment group.
Both groups also recorded an identical median hospital stay of 25 days.
Researchers said the findings indicate that reducing antibiotic exposure may be possible without compromising patient safety in carefully selected cases. However, the trial is ongoing, and further analysis will be necessary before the approach can be considered for wider clinical use.
