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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




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.


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.




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。




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。











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


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.