title: Use of antibacterial prophylaxis for patients with neutropenia. Australian Consensus Guidelines 2011 Steering Committee.
abstract: The use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. Recent evidence has demonstrated non-significant but consistent, improvement in all-cause mortality when fluoroquinolones (FQs) are used as primary prophylaxis. However, the consensus was that this evidence was not strong enough to recommend prophylaxis. The evidence base for FQ prophylaxis is presented alongside current consensus opinion to guide the appropriate and judicious use of these agents. Due consideration is given to patient risk, as it pertains to specific patient populations, as well as the net effect on selective pressure from antibiotics if FQ prophylaxis is routinely used in a target population. The potential costs and consequences of emerging FQ resistance, particularly among Escherichia coli, Clostridium difficile and Gram-positive organisms, are considered. As FQ prophylaxis has been advocated in some chemotherapy protocols, specific regard is given to whether FQ prophylaxis should be used to support these regimens. The group also provides recommendations for monitoring and surveillance of emerging resistance in those centres that have adopted FQ prophylaxis.
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. monica.slavin@petermac.org
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.forename: S
authors.initials: S
authors.lastname: Lingaratnam
authors.forename: L
authors.initials: L
authors.lastname: Mileshkin
authors.forename: D L
authors.initials: DL
authors.lastname: Booth
authors.forename: M J
authors.initials: MJ
authors.lastname: Cain
authors.forename: D S
authors.initials: DS
authors.lastname: Ritchie
authors.forename: A
authors.initials: A
authors.lastname: Wei
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D002173:Cancer Care Facilities / Q000592:standards; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy; D003131:Combined Modality Therapy; D000075202:Contraindications; D016903:Drug Monitoring; D024901:Drug Resistance, Multiple, Bacterial; D019317:Evidence-Based Medicine; D005334:Fever / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D009503:Neutropenia / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D024841:Fluoroquinolones