Antibiotic prophylaxis in afebrile neutropenic patients significantly reduced all-cause mortality. In our review, the most significant reduction in mortality was observed in trials assessing prophylaxis with quinolones. The benefits of antibiotic prophylaxis outweighed the harm such as adverse effects and the development of resistance since all-cause mortality was reduced. As most trials in our review were of patients with haematologic cancer, we strongly recommend antibiotic prophylaxis for these patients, preferably with a quinolone. Prophylaxis may also be considered for patients with solid tumours or lymphoma.
[A comparison of nystatin with norfloxacin for prevention of infection after consolidation therapy in patients with acute leukemia or autologous bone marrow transplantation: a randomized study].
Seventy-three patients mainly receiving consolidation therapy for acute leukemia or autologous bone marrow transplantation were studied in a randomized trial comparing nystatin with norfloxacin (800 mg) given orally QID, for prevention of infection. Both groups were equally distributed in regard to age, disease, and duration of granulocytopenia, although far more patients entered the laminar air flow room in the norfloxacin group. Duration of more than a 39 degrees C fever was much longer in the nystatin group than in the norfloxacin group: Bacteremia, microbiologically documented infections, and fever of unknown origin were more frequently seen in the nystatin group, but there was no significant difference between the two groups. On the other hand, patients without fever during granulocytopenia were more numerous in the norfloxacin group than in the nystatin group (p less than 0.05). Furthermore, three deaths during granulocytopenia occurred in the nystatin group. In conclusion, prophylactic administration of norfloxacin during granulocytopenia showed a significant afebrile period.