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.
Selective antimicrobial modulation of the intestinal flora of patients with acute nonlymphocytic leukemia: a double-blind, placebo-controlled study.
Thirty-three patients with acute nonlymphocytic leukemia were studied during remission-induction treatment in a double-blind, placebo-controlled, randomized study to ascertain the effect on the incidence of infection of an oral regimen of selective antimicrobial modulation (SAM). A decrease in the number of major acquired infections was observed: three infections occurred in 16 patients receiving the SAM regimen compared with eight infections in 17 patients given the placebo. The reduction of infection was correlated with a reduction of fever, with a reduction of the frequency of administration of antimicrobial agents for the treatment of infection, and with the selective elimination of aerobic and facultative anaerobic gram-negative rods from the digestive tract. Substantial unfavorable side effects were not observed.