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

Livio Pagano, Malgorzata Mikulska, Diana Averbuch, Frederic Tissot, Catherine Cordonnier, Murat Akova, Thierry Calandra, Marcello Ceppi, Paolo Bruzzi, Claudio Viscoli, Mahmoud Aljurf, Dina Averbuch, Rosemary Barnes, Ola Blennow, Pierre-Yves Bochud, Emilio Bouza, Stephane Bretagne, Roger Brüggemann, Jordi Carratala, Simone CesaroOliver Cornely, Tina Dalianis, Rafael De La Camara, Peter Donnelly, Lubos Drgona, Rafael Duarte, Hermann Einsele, Dan Engelhard, Christopher Fox, Corrado Girmenia, Andreas Groll, Dag Heldal, Jannick Helweg Larsen, Raoul Herbrecht, Hans Hirsch, Elisabeth Johnson, Galina Klyasova, Minna Koskuenvo, Katrien Lagrou, Russel E. Lewis, Per Ljungman, Johan Maertens, Georg Maschmeyer, Marcio Nucci, Christophe Padoin, Antonio Pagliuca, Zdenek Racil, Patricia Ribaud, Christine Rinaldo, Valérie Rizzi Puechal, Emmanuel Roilides, Christine Robin, Montserrat Rovira, Markus Rupp, Sonia Sanchez, Peter Schellongowski, Peter Sedlacek, Janos Sinko, Monica Slavin, Isabella Sousa Ferreira, Jan Styczynski, Katherine Ward, Anne-Therese Witschi

Research output: Contribution to journalArticle

56 Citations (Scopus)

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
DOIs
Publication statusPublished - 2018

Keywords

  • Ciprofloxacin
  • Febrile neutropenia
  • Infection
  • Infectious Diseases
  • Levofloxacin
  • Microbiology (medical)
  • Multidrug resistance (MDR)
  • Neutropenic
  • Prevention
  • Quinolone

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