Antibiotic prophylaxis for chemotherapy-induced febrile neutropenia in hematologic and solid organ malignancies

ABSTRACT

BACKGROUND AND OBJECTIVE: Febrile neutropenia (FN) frequently develops among cancer patients receiving chemotherapy and is associated with significant morbidity and mortality. Although the use of empiric antibiotics has been a standard of care for FN according to the last 2010 Infectious Disease Society of America (IDSA) guidelines, the role of prophylactic antibiotics in patients with high risk features in preventing febrile neutropenia remains to be elucidated. This study aims to investigate the role of antibiotic prophylaxis in preventing post-chemotherapy FN among patients with hematologic and solid organ malignancies. METHODS: A literature search of published English language clinical trials was performed using PubMed, MEDLINE, and the Cochrane Collaboration from January 1980 - October 2015. Four hundred thirty two articles were extracted from our literature search and narrowed down through specified inclusion and exclusion criteria. Results were analyzed based on 1) incidence of FN in post chemotherapy cancer patients, 2) mortality rate, and 3) incidence of FN with different antibiotics. Assessment of methodological quality of each study was done using the Jadad scale. Odds ratios and Forest plots were computed and generated respectively using RevMan 5.2 (© 2013 the Cochrane Collaboration). RESULTS: Antibiotic prophylaxis reduced the incidence of FN (OR 0.59[0.37, 0.91]). Overall effect was significant; Z= 2.35 (p= 0.02). Febrile episodes occurred less frequently in those patients who received prophylactic antibiotic treatment (OR 0.43 [0.34, 0.53]) Z = 7.59 (p CONCLUSION: Antibiotic prophylaxis reduces the incidence of FN among cancer patients treated with cytotoxic chemotherapy, decreases febrile episodes in neutropenic patients, and overall, prevented FN by up to 3.51-fold.