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Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy

  • Review
  • Intervention

Authors


Abstract

Background

Febrile neutropenia (FN) and other infectious complications are some of the most serious treatment-related toxicities of chemotherapy for cancer, with a mortality rate of 2% to 21%. The two main types of prophylactic regimens are granulocyte (G-CSF) or granulocyte-macrophage colony stimulating factors (GM-CSF); and antibiotics, frequently quinolones or cotrimoxazole. Important current guidelines recommend the use of colony stimulating factors when the risk of febrile neutropenia is above 20% but they do not mention the use of antibiotics. However, both regimens have been shown to reduce the incidence of infections. Since no systematic review has compared the two regimens, a systematic review was undertaken.

Objectives

To compare the effectiveness of G-CSF or GM-CSF with antibiotics in cancer patients receiving myeloablative chemotherapy with respect to preventing fever, febrile neutropenia, infection, infection-related mortality, early mortality and improving quality of life.

Search methods

We searched The Cochrane Library, MEDLINE, EMBASE, databases of ongoing trials, and conference proceedings of the American Society of Clinical Oncology and the American Society of Hematology (1980 to 2007). We planned to include both full-text and abstract publications.

Selection criteria

Randomised controlled trials comparing prophylaxis with G-CSF or GM-CSF versus antibiotics in cancer patients of all ages receiving chemotherapy or bone marrow or stem cell transplantation were included for review. Both study arms had to receive identical chemotherapy regimes and other supportive care.

Data collection and analysis

Trial eligibility and quality assessment, data extraction and analysis were done in duplicate. Authors were contacted to obtain missing data.

Main results

We included two eligible randomised controlled trials with 195 patients. Due to differences in the outcomes reported, the trials could not be pooled for meta-analysis. Both trials showed non-significant results favouring antibiotics for the prevention of fever or hospitalisation for febrile neutropenia.

Authors' conclusions

There is no evidence for or against antibiotics compared to G(M)-CSFs for the prevention of infections in cancer patients.

摘要

背景

接受化療癌症病患使用預防性抗生素或GCSF來預防感染與增加存活

中性球低下發燒症(FN)及其他感染併發症是化學治療中嚴重的相關毒性之一,其死亡率約2 – 21%。目前兩類主要的預防藥物包括顆粒球(GCSF)或顆粒球巨嗜細胞(GMCSF)血球刺激因子,以及抗生素常見如?諾酮(quinolone)或cotrimoxazole。目前重要的治療指引建議於發生中性球低下發燒症高於20%時使用血球刺激因子。然而目前已知這兩類藥物都可以降低感染發生率。過去沒有系統性回顧來比較這兩類藥物,因此我們進行此一系統性回顧。

目標

我們針對接受骨髓抑制化學治療的癌症病患有無發燒,中性球低下發燒症,感染,感染引起的死亡率,早期死亡率及生活品質的改善,來比較使用GCSF或GMCSF合併抗生素的效果。

搜尋策略

我們搜尋考科藍圖書館(The Cochrane Library),MEDLINE,EMBASE,正在進行中的試驗資料,及從1980年到2007年美國臨床癌症學會(American Society of Clinical Oncology)與美國血液學學會(American Society of Hematology)的會議資料。搜尋計畫包含全文和摘要發表。

選擇標準

隨機對照試驗包含所有年齡接受化學治療或骨髓或幹細胞移植的癌症病患,來比較預防性GCSF或GMCSF以及抗生素的使用。兩個研究組都必須接受相同的化學治療配方及其他支持性照護。

資料收集與分析

試驗的資格與品質評估,資料收集與分析都需雙重確認。並且聯絡這些作者以獲取遺漏的資料。

主要結論

我們包含兩個符合資格的隨機對照試驗總共195位病患。因為報告的結果有差異,這些試驗無法匯集來做統合分析(metaanalysis)。兩個試驗都顯示抗生素較能預防發燒或因為中性球低下發燒症而住院的機會,但是無統計學意義。

作者結論

目前針對在癌症病患比較使用抗生素或G(M)CSF,並無支持或反對的證據顯示在預防感染何者為佳。

翻譯人

本摘要由慈濟醫院黃冠博翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

接受化療癌症病患使用預防性抗生素或GCSF來預防感染與增加存活: 使用化學治療(抗癌藥物)或骨髓或幹細胞移植來治療癌症,會干擾免疫系統並降低白血球數目。這會增加病人感染的風險。顆粒球生長因子(GSF)及抗生素都能夠降低癌症治療相關的感染風險。這篇回顧比較抗生素和GSFs對於預防感染及死亡的效果。只有找到兩個研究比較這兩種預防方式。這兩個研究無法匯集一起分析,雖然無統計學意義但卻顯示出病患使用抗生素都有降低感染及發燒的趨勢。這需要更多研究來決定在癌症病患最能夠對抗感染的預防方法。

Plain language summary

Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy

Cancer treatment with chemotherapy (anti-cancer drugs) or bone marrow or stem cell transplantation disrupts the immune system and lowers white blood cell counts. This increases a person's risk of infection. Both granulocyte colony stimulating factors (GSF) and antibiotics can reduce the risk of infection associated with cancer treatments. The review compared the effectiveness of antibiotics to GSFs for the prevention of infection and death. Only two studies were found that compared the two methods of prophylaxis. The studies could not be pooled but both showed a non-significant trend towards a reduction of infection or fever in patients receiving antibiotics. More research is needed to determine the best prophylaxis against infection in cancer patients.

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