Prophylaxis with Fluoroquinolones for Bacterial Infections in Neutropenic Patients: A Meta-Analysis

Abstract

We conducted a two-part meta-analysis to assess the effectiveness of fluoroquinolones for preventing bacterial infections in granulocytopenic patients who are receiving chemotherapy for malignancies. Overall, 19 randomized studies met selection criteria and were included in this meta-analysis of 2,112 patients. Thirteen studies that compared the fluoroquinolones alone with control regimens (co-trimoxazole, oral nonabsorbable antibiotics, or placebo) and six studies that compared the fluoroquinolones plus prophylaxis for bacteremia due to gram-positive bacteria with control regimens (fluoroquinolones or oral nonabsorbable antibiotics) were included in the two meta-analyses. The results of the first meta-analysis indicate that fluoroquinolones alone are effective in preventing gram-negative bacteremia (overall odds ratio [OR], 0.09; 95% confidence interval [CI], 0.05-0.16; P < .001), but not gram-positive bacteremia (OR, 1.05; 95% CI, 0.76-1.45; P = .7), fever-related morbidity (OR, 0.76; 95% CI, 0.56-1.04; P = .09), and infection-related mortality (OR, 0.79; 95% CI, 0.47-1.34; P = .4). The results of the second meta-analysis indicate that a combination of fluoroquinolones plus prophylaxis for gram-positive bacteremia (penicillin, vancomycin, or macrolides) significantly reduces the occurrence of gram-positive bacteremia (OR, 0.46; CI, 0.33-0.63; P < .001) without affecting the incidence of fever-related morbidity (OR, 0.83; 95% CI, 0.62-1.13; P = .2) and infection-related mortality (OR, 0.74; 95% CI, 0.40-1.38; P = .3)

The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit

“…Meta-analysis has shown consistent decreases in gram-negative infections (bacteremia), with no reduction in mortality. 8,9 A recent study suggested increased mortality in hematological malignancy patients upon discontinuation of levofloxacin prophylaxis. 10 The major concern in implementing prophylaxis is the occurrence of antibiotic resistance.…”

Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation

“…For Gramnegative organisms, prevention of disease with antibiotics, in particular fluoroquinolones, has been controversial because of concerns about the emergence of drug resistance. 46,47 In both the early and late post transplant periods, routine use of IVIG prophylaxis has not consistently shown long-term survival benefit. [48][49][50] In the absence of infection and severe hypogammaglobulinemia (serum IgG o400 mg/dl), routine use of IVIG is not indicated.…”

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

“…16 A recent meta-analysis indicated that a combination of fluoroquinolones and prophylaxis against gram-positive organisms reduces the occurrence of gram-positive bacteremia in granulocytopenic patients. 17 The addition of erythromycin to ciprofloxacin prophylaxis failed to be of any benefit following transplantation in one study. 18 However, the use of alternative agents with activity against gram-positive organisms such as oral roxithromycin, 19,20 intravenous penicillin, 21 intravenous cephalothin, 19 oral amoxicillin, 22 oral rifampicin 23 and intravenous vancomycin 24 have all significantly reduced the incidence of viridans streptococcal bacteremia.…”