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.
Chemoprophylaxis with ciprofloxacin in ovarian cancer patients receiving paclitaxel: a randomized trial.
The objective of this study was to evaluate the efficacy of oral ciprofloxacin in preventing febrile morbidity superimposed on the neutropenia induced from a paclitaxel regimen in ovarian cancer patients. Eligible patients received paclitaxel at doses of 135 to 175 mg/m2 alone or in combination with a platinum agent. They were randomized to either an observation (control) group or a ciprofloxacin prophylaxis group. Patients in the ciprofloxacin group received 500 mg ciprofloxacin orally twice a day once the absolute neutrophil count (ANC) was less than 500/mm3 and continued until the ANC was greater than 1000/mm3. Ninety patients were enrolled between the control (n = 45) and ciprofloxacin (n = 45) groups. They received 371 cycles of a paclitaxel-based regimen with 177 and 194 cycles in the control and ciprofloxacin groups, respectively. Ciprofloxacin prophylaxis was prescribed for 138 (71%) of the cycles in the ciprofloxacin group and was given for a mean duration of 7.7 days per cycle. The groups were similar in disease status and risk factors for neutropenia. Fifteen patients in the control group developed febrile neutropenia versus 12 of those in the ciprofloxacin group (P = 0.69). The mean ANC and mean length of hospital stay for neutropenic fever were also similar between groups. There was a greater frequency of an ANC < 100 associated with those prophylaxed with ciprofloxacin (P = 0.01). Only 44% of the febrile episodes were associated with a positive culture. Staphylococcus aureus was the most frequently reported organism isolated. Considering these results, it does not appear that febrile neutropenia is reduced by ciprofloxacin during grade IV neutropenia.