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The conundrum of fluoroquinolone prophylaxis

Nature Clinical Practice Oncology volume 3, pages 524–525 (2006)Cite this article

Since the advent of cytotoxic chemotherapy and the recognition of the attendant infection risk,1 clinicians have struggled to prevent serious neutropenia-related bacterial infections. During the 1990s, fluoroquinolone antibiotics gained popularity because of their broad spectrum of activity, excellent bioavailability and infrequent side effects.2 Although trials demonstrated that fluoroquinolone prophylaxis reduced the number of documented infections, febrile days and hospital days, survival benefit was never demonstrated.3,4,5 Even with this limitation, fluoroquinolones are given widely; not surprisingly, this approach has increased fluoroquinolone-resistant Gram-negative pathogens and severe viridans streptococcal infections in patients with cancer.6,7,8

Clinical care guidelines have not endorsed the routine use of fluoroquinolones for prophylaxis, except in the 'high-risk' settings of allogeneic hematopoietic stem-cell transplantation or acute leukemia induction therapy, because of their disadvantages in terms of drug resistance, cost and toxicity.9 The dilemma for those managing patients with cancer and neutropenia, therefore, is whether or not the potential (or real) advantages provided by fluoroquinolone prophylaxis offset the potential problems.

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References

  1. Bodey GP et al. (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64: 328–340

    Article  CAS  Google Scholar 

  2. Karp JE et al. (1987) Oral norfloxacin for prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 106: 1–7

    Article  CAS  Google Scholar 

  3. Lew MA et al. (1995) Ciprofloxacin versus trimethoprim/sulfamethoxazole for prophylaxis of bacterial infections in bone marrow transplant recipients: a randomized, controlled trial. J Clin Oncol 13: 239–250

    Article  CAS  Google Scholar 

  4. Bow EJ et al. (1996) Quinolone-based antibacterial chemoprophylaxis in neutropenic patients: effect of augmented gram-positive activity on infectious morbidity. National Cancer Institute of Canada Clinical Trials Group. Ann Intern Med 125: 183–190

    Article  CAS  Google Scholar 

  5. Engels EA et al. (1998) Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis. J Clin Oncol 16: 1179–1187

    Article  CAS  Google Scholar 

  6. Kern WV et al. (1994) Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center. Antimicrob Agents Chemother 38: 681–687

    Article  CAS  Google Scholar 

  7. Baum HV et al. (2000) Prevalence of ciprofloxacin-resistant Escherichia coli in hematologic-oncologic patients. Infection 28: 278–281

    Article  CAS  Google Scholar 

  8. Bochud PY et al. (1994) Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med 97: 256–264

    Article  CAS  Google Scholar 

  9. National Comprehensive Cancer Network (2005) Fever and neutropenia: Clinical Practice Guidelines in Oncology—v.1.2006. [http://www.nccn.org/professionals/physician_gls/PDF/fever.pdf] (accessed 23 August 2006)

  10. Gafter-Gvili A et al. (2005) Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 142: 979–995

    Article  Google Scholar 

  11. Bucaneve G et al. (2005) Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 353: 977–987

    Article  CAS  Google Scholar 

  12. Cullen M et al. (2005) Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 353: 988–998

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Director of Immunocompromised Host Infectious Diseases at the University of Nebraska Medical Center, Omaha, NE

    Alison Freifeld

  2. Memorial Sloan–Kettering Cancer Center, New York

    Kent Sepkowitz

  3. Weill Medical College of Cornell University, New York, NY, USA

    Kent Sepkowitz

Authors
  1. Alison Freifeld
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  2. Kent Sepkowitz
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Correspondence to Alison Freifeld.

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The authors declare no competing financial interests.

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Freifeld, A., Sepkowitz, K. The conundrum of fluoroquinolone prophylaxis. Nat Rev Clin Oncol 3, 524–525 (2006). https://doi.org/10.1038/ncponc0632

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