Antibiotic prophylaxis in neutropenic patients

Abstract

New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. For patients with acute leukemia or those who undergo bone marrow transplantation, prophylaxis with fluoroquinolones diminished the risk of death from any cause by 33% (95% confidence interval [95% CI], 2-54%). Thus, 55 patients who have acute leukemia or who undergo bone marrow transplantation must receive prophylaxis to prevent 1 death. In 4 studies that included patients with solid tumors or lymphoma, prophylaxis reduced the rate of death during the first month (relative risk, 0.51; 95% CI, 0.27-0.97), and 82 patients had to receive prophylaxis to prevent 1 death. The main argument brought against prophylaxis is the induction of resistance. Patients who received prophylaxis did not experience more infections caused by resistant strains than patients in the control group. The recent GIMEMA study was con- N ew evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. A systematic review and meta-analysis of randomized controlled trials 1 demonstrated that death from all causes was reduced by 34% (95% confidence interval [95% CI], 21-45%) in neutropenic patients who received any antibiotic prophylaxis and by 40% (95% CI, 17-56%) in patients who received quinolones for prophylaxis. in addition, the occurrence of febrile episodes and bacterial infections decreased significantly (Table 1). Most of the studies that were included in that meta-analysis addressed patients with hematologic malignancies. In the most recent and largest randomized controlled trial that included patients in whom neutropenia was expected to occur for more than 7 days (mainly with acute leukemia and autologous peripheral blood stem cell transplantation), 2 patients who received levofloxacin as prophylaxis had a relative risk (RR) of 0.54 (95% CI, 0.25-1.16) for mortality compared with the placebo group: a Dr. Cullen has received honoraria from Sanofi Aventis.We thank Dr. Vivianne Tjan-Heijnen and Ms. Muriel Debois for supplying us with full data regarding mortality from their study.

Bloodstream infections in neutropenic cancer patients: A practical update

“…100,101 Only when these results were included in a meta-analysis together with previous studies, a statistically significant reduction in mortality was reported. 102 Since few studies have been performed in the last decade, an update of this meta-analysis did not report any significant changes. 103 Of note, 2 recent meta-analyses, one involving exclusively HSCT recipients (over 1400 patients, mostly after autologous HSCT) and the other including only randomized placebo-controlled and blinded studies failed to show significant survival benefit of FQ prophylaxis.…”

Supportive care in severe and very severe aplastic anemia

“…9 Therefore, it seems reasonable to deduce the recommendations from the large number of randomized controlled clinical trials and the respective meta-analyses, which are available for other neutropenic conditions. [10][11][12][13][14][15] If the patient's condition allows (ECOG (Eastern Cooperative Oncology Group) performance status 0-2), the evaluation of patients with the possible diagnosis of AA can be performed as an outpatient.…”

Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients

“…[4][5][6][7] The use of prophylactic antibiotics in HSCT recipients has been an important measure reducing the risk of BSIs, particularly in the allogeneic setting. [7][8][9][10][11][12] Since the early 1970s, selective gut decontamination, aiming to suppress overgrowth and translocation of intestine aerobic microflora, has been suggested for reducing BSIs in HSCT recipients, particularly threats from Gram-negative pathogens. [13][14][15][16][17][18] Combination regimens with oral non-absorbable or partly absorbable antimicrobials, such as trimethoprim sulfamethoxazole (TMP-SMX), metronidazole, vancomycin, nystatin, nalixidic acid or pipemidic acid and so on, were commonly used in the early decades.…”