Efficacy of levofloxacin as an antibacterial prophylaxis for acute leukemia patients receiving intensive chemotherapy: a systematic review and meta-analysis

Abstract

Objectives: The incidence of febrile neutropenia (FN) in acute leukemia patients following induction or consolidation chemotherapy is high. Several clinical practice guidelines recommend the use of a fluoroquinolone prophylaxis to prevent bacterial infection in patients being prone to prolonged profound neutropenia. Methods: This systematic review and meta-analysis aimed to investigate the efficacy and complications of levofloxacin as a prophylaxis for FN patients following chemotherapy for acute leukemia. Two databases from MEDLINE and EMBASE were searched for published studies indexed before 10 July 2018. Results: A total of 862 acute leukemia patients were included, with 356 in the levofloxacin prophylaxis arm and 506 in the no-prophylaxis arm. Patients receiving levofloxacin had a significantly lower FN rate than patients who did not receive the antibiotic prophylaxis (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.32-0.58, p < .00001, I 2 = 0%). The rate of microbiologically documented infection in the no-prophylaxis group was higher than that for the levofloxacin prophylaxis group (OR: 0.45, 95% CI: 0.34-0.60, p < .00001, I 2 = 0%). The bacteremia rate in the levofloxacin prophylaxis group was significantly lower than that for the no-prophylaxis group (OR: 0.45, 95% CI: 0.31-0.66, p < .00001, I 2 = 0%). However, the mortality rates of the two groups were quite similar between the two groups (OR: 0.67, 95% CI: 0.34-1.33, p = .26, I 2 = 0%). Conclusions: Although the levofloxacin prophylaxis for the acute leukemia patients receiving intensive chemotherapy showed advantages for infectious complications, it did not affect mortality.

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

“…However, a meta-analysis of studies published during 2006–2014 did not confirm a reduction in mortality on fluoroquinolone prophylaxis but still showed lower rates of BSI and of episodes of fever during neutropenia [ 8 , 9 ]. The most recent meta-analysis, comprising adult and pediatric studies, found that levofloxacin PPX during intensive chemotherapy for acute leukemia significantly reduced febrile neutropenia, bacteremia, and microbiologically documented infection rates, but did not improve the death rate [ 10 ]. While the effectiveness of PPX in adult patients has been addressed in several studies, data regarding pediatric patients are limited [ 11 ].…”

The Management of Hematologic Patients with Bloodstream Infections Due to Multi-Drug Resistant Bacteria: Where Do We Stand? From Antibacterial Prophylaxis to the Treatment of Septic Shock

“…A recent meta-analysis investigated the efficacy of levofloxacin in patients with acute leukemia. Prophylaxis reduced the incidence of febrile neutropenia and microbiologically documented infections but did not have effect on mortality [21].…”

Infectious complications of induction treatment for acute myeloid leukaemia using the "7 + 3" protocol without antibiotic prophylaxis - 15 years of experience of one clinical site

“…However, the use of antibiotic prophylaxis did not reduce mortality (P=0.26) (ref. 29 ). Table 4 shows an overview of infectious mortality in selected published cohorts.…”