Interim Findings from END Study Highlight Early Antibiotic Discontinuation Benefits
A recent trial indicates that stopping antibiotics early in febrile neutropenia patients may reduce exposure without increasing severe outcomes.
Early antibiotic discontinuation in febrile neutropenia shows reduced exposure without severe outcomes.
The study involved 157 participants, with comparable severe event rates between early discontinuation and standard care.
Patients who stopped antibiotics early experienced significantly more antibiotic-free days.
Interim results from the END (Early Neutropenic Fever De-escalation of Antibiotics) study presented at IDWeek 2026 reveal that early discontinuation of antibiotics in febrile neutropenia patients can lead to reduced antibiotic exposure without raising the risk of severe complications. This ongoing trial focuses on patients with hematologic malignancies who are hospitalized with high-risk febrile neutropenia and have no identified bacterial source after 48 hours of fever absence.
Current medical guidelines advocate for the continuation of broad-spectrum antibiotics until bone marrow recovery in high-risk febrile neutropenia patients, particularly when no bacterial source is detected. However, prolonged antibiotic use can lead to adverse effects such as multidrug resistance and Clostridioides difficile infections, which may complicate patient recovery post-cellular therapy. The END study aims to evaluate whether early antibiotic cessation can safely minimize unnecessary treatment.
Conducted at a single cancer center, the Phase IV trial randomized 157 adults with hematologic malignancies. Participants were divided into two groups: one receiving early discontinuation of intravenous antibiotics and the other continuing standard treatment until blood counts improved. An interim analysis assessed severe outcomes, including mortality and septic shock, by Day 60, alongside the duration of antibiotic exposure.
The study's findings indicate that between May 2024 and April 2026, 148 participants completed follow-up, with 73 undergoing early discontinuation and 75 receiving standard care. Severe event rates were similar, with 11.0% in the early discontinuation group compared to 13.3% in the standard care group. Additionally, the median hospital stay was consistent at 25 days for both groups. Notably, patients who discontinued antibiotics early enjoyed a mean of 10.5 antibiotic-free days during neutropenia, significantly higher than the 3.8 days for those receiving standard care.
These preliminary results suggest that early antibiotic discontinuation may be a viable option for selected high-risk febrile neutropenia patients, potentially enhancing antibiotic stewardship without compromising patient safety. However, further analyses are necessary to determine the broader applicability of these findings in clinical practice as the trial continues.
