West Nile Viral Encephalitis in an HIV-Positive Woman in New York

In the July 29 issue, Kern et al. 1 and Freifeld et al. 2 reach similar conclusions about the efficacy of oral as compared with intravenous antibiotic therapy for febrile patients with neutropenia due to cancer chemotherapy who have a low risk of complications.It is a common mistake to assume that the absence of a statistical difference between two treatments means that they are equivalent.This criticism is of particular importance in a study involving a relatively small patient population, with a low failure rate in each group.In the study by Kern et al., the end point was the rate of treatment success (i.e., recovery without a change in the regimen).Similarly, in the study by Freifeld et al., treatment was considered successful if the patient survived without a change in the regimen.The prognosis is usually good in low-risk patients with fever and neutropenia, particularly when the origin of the fever is unexplained. 3 As Finberg and Talcott note in their accompanying editorial, 4 the end point of these studies should have been the rate of treatment failure, not success.With treatment failure as the end point, neither study appears to have sufficient power to support a definite conclusion.In our opinion, the authors do not provide sufficient data on which to base a conclusion that oral antibiotics are as safe and effective as antibiotics delivered intravenously in low-risk patients with chemotherapyinduced neutropenia.