Use of antibacterial prophylaxis for patients with neutropenia

Authors


  • Funding: Victorian Integrated Cancer Services, administered by Western and Central Melbourne Integrated Cancer Services.

  • Conflict of interest: The following authors are consultants or advisory committee members or receive honoraria, fees for service, or travel assistance (independent of research-related meetings) from; or have research or other associations with the organisations listed: Monica Slavin – Gilead, Merck Sharp & Dohme, Pfizer, Schering Plough; Senthil Lingaratnam – Victorian Integrated Cancer Services; Andrew Wei – Celgene, Hospira, Novartis; Karin Thursky – Gilead, Merck Sharp & Dohme, Pfizer, Schering Plough.

Monica Slavin, Department of Infectious Diseases, Peter MacCallum Cancer Centre, St. Andrew's Place, East Melbourne, Vic. 3002, Australia. Email: monica.slavin@petermac.org

Abstract

The use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. Recent evidence has demonstrated non-significant but consistent, improvement in all-cause mortality when fluoroquinolones (FQs) are used as primary prophylaxis. However, the consensus was that this evidence was not strong enough to recommend prophylaxis. The evidence base for FQ prophylaxis is presented alongside current consensus opinion to guide the appropriate and judicious use of these agents. Due consideration is given to patient risk, as it pertains to specific patient populations, as well as the net effect on selective pressure from antibiotics if FQ prophylaxis is routinely used in a target population. The potential costs and consequences of emerging FQ resistance, particularly among Escherichia coli, Clostridium difficile and Gram-positive organisms, are considered. As FQ prophylaxis has been advocated in some chemotherapy protocols, specific regard is given to whether FQ prophylaxis should be used to support these regimens. The group also provides recommendations for monitoring and surveillance of emerging resistance in those centres that have adopted FQ prophylaxis.

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