Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines

a joint venture of the European Group for Blood and Marrow Transplantation (EBMT), the European Organization for Research and Treatment of Cancer (EORTC), the International Immunocompromised Host Society (ICHS) and the European Leukemia Net (ELN), European Conference on Infections in Leukemia (ECIL)

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Abstract

Objectives Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. Methods Literature review of randomised controlled trials (RCT) and observational studies published in years 2006–2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. Results Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73–1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43–0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20–0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. Conclusions The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.

Original languageEnglish
Pages (from-to)20-37
Number of pages18
JournalJournal of Infection
Volume76
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Bibliographical note

Funding Information:
The ECIL-6 meeting has been supported by unrestricted educational grants from Basilea, Gilead Sciences, Merck and Pfizer.

Publisher Copyright:
© 2017 The British Infection Association

Keywords

  • Ciprofloxacin
  • Febrile neutropenia
  • Infection
  • Levofloxacin
  • Multidrug resistance (MDR)
  • Neutropenic
  • Prevention
  • Quinolone

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