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Evidence summaries

Antibiotic Prophylaxis for Neutropenic Patients

Antibiotic prophylaxis reduces all-cause mortality in afebrile neutropenic patients following chemotherapy, compared to placebo or no intervention. The evidence is strongest for quinolones. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 109 studies performed between the years 1973 to2010, with a total of 13 579 subjects assessing the effects of antibiotic prophylaxis for patients neutropenic following chemotherapy, on reducing mortality and incidence of bacterial infections compared to placebo or no intervention. The main findings are summarized here:

OutcomesNumber of patients (trials)Assumed risk (control)Correspondinf risk (intervention)Relative effect (95% CI)
All-cause mortality5 635 (46)88 per 100057 per 1000 (47 to 68)RR 0.66 (0.55 - 0.79)
Bacteremia6 390 (53)209 per 1000105 per 1000 (88 to 125)RR 0.50 (0.43 - 0.60)
Febrile episodes6 658 (54)607 per 1000486 per 1000 (449 to 528)RR 0.80 (0.74 - 0.87)
All-cause mortality (quinolole vs. placebo)3 798 (20) RR 0.54 (0.40 - 0.74)
Side effects requiring discontinuation2 281 (18) RR 2.06 (1.32 - 3.81)

A systematic review 2 including 19 RCTs with a total of 2,112 subjects was abstracted in DARE. Prophylaxis with fluoroquinolones was shown to reduce the frequency of gramnegative bacteraemia (OR 0.09, 95% CI 0.05 to 0.16) without affecting the frequency of gram-positive bacteraemia (OR 1.05, 95% CI 0.76 to 1.45) or infection-related mortality (OR 0.79, 95% CI 0.47 to 1.34). The addition of gram-positive prophylaxis to fluoroquinolone prophylaxis significantly reduced the incidence of gram-positive bacteraemia (OR 0.46, 95% CI 0.33 to 0.63) without affecting the incidence of fever-related mortality (OR 0.83, 95% CI 0.62 to 1.13).

Another systematic review 3 including 18 studies with a total of 707 subjects receiving quinolones, 334 receiving trimethoprim/sulfamethoxazole (TMS) and 367 receiving no prophylaxis was abstracted in DARE. Compared with no prophylaxis, quinolones significantly reduced the incidence of gram-negative bacterial infections (RR 0.21, 95% CI 0.12 to 0.37), total infections (RR 0.54, 95% CI 0.31 to 0.95) and fevers (RR 0.85, 95% CI 0.73 to 0.99).

References

  • Gafter-Gvili A, Fraser A, Paul M et al. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev 2012;1:CD004386. [PubMed]
  • Cruciani M, Rampazzo R, Malena M, Lazzarini L, Todeschini G, Messori A, Concia E. Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis. Clin Infect Dis 1996 Oct;23(4):795-805. [PubMed][DARE]
  • Engels EA, Lau J, Barza M. Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis. J Clin Oncol 1998 Mar;16(3):1179-87. [PubMed] [DARE]

Primary/Secondary Keywords