Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Aug;8(10):4536-4546.
doi: 10.1002/cam4.2395. Epub 2019 Jul 5.

Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials

Grace Egan  1 , Paula D Robinson  2 , Juan P D Martinez  3 , Sarah Alexander  1 , Roland A Ammann  4 , L Lee Dupuis  5 , Brian T Fisher  6 , Thomas Lehrnbecher  7 , Bob Phillips  8 , Sandra Cabral  2 , George Tomlinson  3   9 , Lillian Sung  1   9
Affiliations
Comparative Study

Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials

Grace Egan et al. Cancer Med. 2019 Aug.

Abstract

Purpose: To determine the efficacy and safety of different prophylactic systemic antibiotics in adult and pediatric patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation (HSCT).

Methods: We conducted a systematic review and performed searches of Ovid MEDLINE, MEDLINE in-process and Embase; and Cochrane Central Register of Controlled Trials. Studies were included if patients had cancer or were HSCT recipients with anticipated neutropenia, and the intervention was systemic antibacterial prophylaxis. Strategies synthesized included fluoroquinolone vs no antibiotic/nonabsorbable antibiotic; fluoroquinolone vs trimethoprim-sulfamethoxazole; trimethoprim-sulfamethoxazole vs no antibiotic; and cephalosporin vs. no antibiotic. Fluoroquinolone vs cephalosporin and levofloxacin vs ciprofloxacin were compared by network meta-analysis. Primary outcome was bacteremia.

Results: Of 20 984 citations screened, 113 studies comparing prophylactic antibiotic to control were included. The following were effective in reducing bacteremia: fluoroquinolone vs no antibiotic/nonabsorbable antibiotic (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.41-0.76), trimethoprim-sulfamethoxazole vs no antibiotic (RR 0.59, 95% CI 0.41-0.85) and cephalosporin vs no antibiotic (RR 0.30, 95% CI 0.16-0.58). Fluoroquinolone was not significantly associated with increased Clostridium difficile infection (RR 0.62, 95% CI 0.31-1.24) or invasive fungal disease (RR 1.28, 95% CI 0.79-2.08) but did increase resistance to fluoroquinolone among bacteremia isolates (RR 3.35, 95% CI 1.12 to 10.03). Heterogeneity in fluoroquinolone effect on bacteremia was not explained by evaluated study, population, or methodological factors. Network meta-analysis revealed no direct comparisons for pre-specified analyses; superior regimens were not identified.

Conclusions: Fluoroquinolone, trimethoprim-sulfamethoxazole, and cephalosporin prophylaxis reduced bacteremia. A clinical practice guideline to facilitate prophylactic antibiotic decision-making is required.

Keywords: antibiotic prophylaxis; cancer; meta-analysis; randomized trials.

PubMed Disclaimer

Conflict of interest statement

GE, PDR, JPDM, SA, RAA, LLD, BP, SC, GT and LS declare no potential conflicts of interest. BTF's institution receives research funding from Pfizer and Merck, and he serves on a Data Safety Monitoring Board for Astellas. TL has received research grants from Gilead Sciences, is a consultant to Astellas, Basilea, Gilead Sciences, and Merck/MSD, and served at the speaker's bureau of Astellas, Gilead Sciences, Merck/MSD, and Pfizer.

Figures

Figure 1
Figure 1
Flow diagram depicting study identification, selection, and reasons for exclusion
Figure 2
Figure 2
Forest plot of bacteremia rate among studies comparing any fluroquinolone vs no antibiotic or nonabsorbable antibiotic. Squares to the left of the vertical line mean that bacteremia was reduced with fluoroquinolone. Horizontal lines through the squares represent 95% confidence intervals (CIs). The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Sung L, Aplenc R, Zaoutis T, Groll AH, Gibson B, Lehrnbecher T. Infections in pediatric acute myeloid leukemia: lessons learned and unresolved questions. Pediatr Blood Cancer. 2008;51(4):458‐460. - PubMed
    1. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258‐2266. - PubMed
    1. Petersen FB, Buckner CD, Clift RA, et al. Prevention of nosocomial infections in marrow transplant patients: a prospective randomized comparison of systemic antibiotics versus granulocyte transfusions. Infect Control. 1986;7(12):586‐592. - PubMed
    1. Sung L, Nathan PC, Alibhai SM, Tomlinson GA, Beyene J. Meta‐analysis: effect of prophylactic hematopoietic colony‐stimulating factors on mortality and outcomes of infection. Ann Intern Med. 2007;147(6):400‐411. - PubMed
    1. Sung L, Nathan PC, Lange B, Beyene J, Buchanan GR. Prophylactic granulocyte colony‐stimulating factor and granulocyte‐macrophage colony‐stimulating factor decrease febrile neutropenia after chemotherapy in children with cancer: a meta‐analysis of randomized controlled trials. J Clin Oncol. 2004;22(16):3350‐3356. - PubMed

Publication types

MeSH terms

Substances