title: Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis to estimate the efficacy of quinolone antibiotics in preventing infections, fevers, and deaths among cancer patients neutropenic following chemotherapy.
  
  
  METHODS
  We searched MEDLINE to identify randomized trials of quinolone prophylaxis, controlled either with no prophylaxis or trimethoprim/sulfamethoxazole (TMS) prophylaxis. We pooled relative risks for outcomes using a random-effects model.
  
  
  RESULTS
  Eighteen trials with 1,408 subjects were included. Compared with no prophylaxis, quinolones significantly reduced the incidence of gram-negative bacterial infections (relative risk, 0.21; 95% confidence interval [CI], 0.12 to 0.37), microbiologically documented 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 alter the incidence of gram-positive bacterial, fungal, or clinically documented infections, or infection-related deaths. Results were similar for trials that used TMS as the control regimen. Among those who received quinolones, the incidence of infections due to quinolone-resistant organisms was 3.0% (95% CI, 1.7% to 5.2%) for gram-negative species and 9.4% (95% CI, 5.3% to 16.3%) for gram-positive species. Based on limited data, the incidence of quinolone-resistant infections was not higher among quinolone recipients than controls. With fever as outcome, blinded trials found quinolones less efficacious than did unblinded trials.
  
  
  CONCLUSIONS
  Quinolone prophylaxis substantially reduces the incidence of various infection-related outcomes, but not deaths, in these patients. Although this reduction in infections may translate into a decrease 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 infections are uncommon, but continued vigilance is warranted.
authors.affiliation: Tupper Research Institute, Department of Medicine, New England Medical Center, Boston, MA 02111, USA. eric.engels@es.nemc.org
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
authors.forename: J
authors.initials: J
authors.lastname: Lau
authors.forename: M
authors.initials: M
authors.lastname: Barza
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D005334:Fever; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology; D009503:Neutropenia / Q000139:chemically induced* / Q000276:immunology; D009894:Opportunistic Infections / Q000517:prevention & control*; D015363:Quinolones / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D015363:Quinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination