Treatment with fluorated quinolones of febrile neutropenia in patients with hematologic malignancies.
The use of fluoroquinolones in the treatment of cytotoxic therapy-induced febrile neutropenia is controversial.


OBJECTIVE
The aim of the study was to compare the therapeutic effect of fluoroquinolones with that of standard antibiotic regimens in patients with hematologic malignacies and febrile neutropenia following antineoplastic chemotherapy.


METHODS
This is a prospective randomized study including 129 patients with 141 neutropenic episodes divided into two groups. Fluoroquinolones are used in the trial group and broad-spectrum beta-lactam antibiotics in the control group. The data are analyzed using alternative analysis, non-parametrical chi-square test and Student-Fisher t-test.


RESULTS
The febrile neutropenic episodes were classified as fever of unknown origin (50.4%) and documented infection (49.6%). In the category "fever of unknown origin" no statistically significant difference was found in the clinical effect, patient survival, general and infectious lethality between the trial and control group. In the category "documented infection" the trial group showed significantly lower therapeutic effect and lower infection-free survival of the patients. The clinical effect and infection-free survival after treatment with fluoroquinolones were significantly lower in the category "documented infection" than in the category "fever of unknown origin".


CONCLUSIONS
Fluoroquinolones can be alternative drugs to the standard antibiotic regimens in the treatment of febrile neutropenia in cases of fever of unknown origin. Fluoroquinolone monotherapy is not recommended in cases of febrile neutropenia with documented infection.
Nenova
Ivanka S
IS
Clinic of Hematology, Medical University Plovdiv, Plovdiv, Bulgaria.
Goranov
Stefan E
SE
Mateva
Nonka G
NG
Ananoshtev
Nikola H
NH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007239:Infections / Q000150:complications / Q000188:drug therapy; D007769:Lactams; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy*; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D024841:Fluoroquinolones; D007769:Lactams