EFFICACY OF QUINOLONE PROPHYLAXIS IN NEUTROPENIC CANCER-PATIENTS - A METAANALYSIS

Purpose: To perform a meta-analysis to estimate the efficacy of quinol one antibiotics in preventing infections, fevers, and deaths among can cer patients neutropenic following chemotherapy. Methods: We searched MEDLINE to identify randomized trials of quinolone prophylaxis, contro lled either with no prophylaxis or trimethoprim/sulfamethoxazole (TMS) prophylaxis. We pooled relative risks for outcomes using a random-eff ects model. Results: Eighteen trials with 1,408 subjects were included . Compared with no prophylaxis, quinolones significantly reduced the i ncidence of gram-negative bacterial infections (relative risk, 0.21; 9 5% confidence interval [CI], 0.12 to 0.37), microbiologically document ed infections (0.65; 0.50 to 0.85), total infections (0.54; 0.31 to 0. 95), and fevers (0.85; 0.73 to 0.99). Quinolone prophylaxis did not al ter the incidence of gram-positive bacterial, fungal,or clinically doc umented infections, or infection-related deaths. Results were similar for trials that used TMS as the control regimen. Among those who recei ved quinolones, the incidence of infections due to quinolone-resistant organisms was 3.0% (95% CI, 1.7% to 5.2%) for gramnegative species an d 9.4% (95% CI, 5.3% to 16.3%) for gram-positive species. Based on lim ited data, the incidence of quinolone-resistant infections was not hig her among quinolone recipients than controls. With fever as outcome, b linded trials found quinolones less efficacious than did unblinded tri als. Conclusion: Quinolone prophylaxis substantially reduces the incid ence of various infection-related outcomes, but not deaths, in these p atients. Although this reduction in infections may translate into a de crease in morbidity, the reduction in fevers (and by extension, use of empiric antibiotics) appears small, and blinded trials provided less evidence for benefit than unblinded trials. Quinolone-resistant infect ions are uncommon, but continued vigilance is warranted. (C) 1998 by A merican Society of Clinical Oncology.