Evaluation of antibiotic prophylaxis in neutropenic patients with haematological malignancies

The benefits of oral prophylaxis for neutropenia have remained controversia l up to now. We evaluated retrospectively the effect of antibiotic prophyla xis with ciprofloxacin and penicillin on the prevention of bacterial infect ions in 112 cases of prolonged neutropenia in adult patients treated for ha ematological malignancies. 41 patients received prophylaxis between Decembe r 1993 and November 1994 while 71 patients did not receive prophylaxis betw een December 1994 and November 1995. There were no significant differences between groups in age, sex, type or stage of haemopathy, type of chemothera py and duration of neutropenia. The antibiotic prophylaxis reduced the numb er of overall infections (p = 0.05) and the number of gram-negative bactera emias (p = 0.02). The median time to the onset of fever, the duration of fever, the duration of antibiotic treatment, the duration of hospitalisation or admission to th e intensive care unit, the number of serious complications or death were no t influenced by antibiotic prophylaxis. The prophylaxis did not reduce the overall incidence of bacteraemia, of clinically documented infections or of fever of unknown origin. This retrospective study confirms that oral proph ylaxis with ciprofloxacin and penicillin decreases the incidence of infecti ons and, in particular, of gram-negative bacteraemia, but does not modify t he overall morbidity and mortality in our patients. In view of the risk of emergence of bacterial resistance, these data do not support the routine us e of oral antibiotic prophylaxis in neutropenic patients with haematologica l malignancies.