The Role of Quinolones as Prophylaxis in Neutropenic Patients
Brahm H. Segal, MD
Head, Division of Infectious Diseases, Roswell Park Cancer Institute, Buffalo, New York, USA
Neutropenia resulting from antineoplastic regimens is the major risk factor for infectious complications in patients with cancer. Patients with cancer and neutropenia have different levels of risk for infectious diseases. The degree and duration of neutropenia, presence of mucositis, immune impairment resulting from the underlying malignancy, and additional co-morbidities all influence the risk for infectious complications. Although evaluated in randomized trials over decades, antibacterial prophylaxis in patients with chemotherapy-induced neutropenia remains controversial. Antibacterial prophylaxis can reduce the incidence of Gram-negative infections and fever in neutropenic patients, and one meta-analysis showed a survival benefit of antibacterial prophylaxis. Quinolones are probably the most commonly used prophylactic agent in adults with chemotherapy-induced neutropenia. Based on concerns about selecting for antibiotic-resistant bacteria, antibacterial prophylaxis is generally restricted to neutropenic patients at high risk of infectious complications, such as those with neutropenia expected to last at least 7 days. This review will address the benefits and risks associated with quinolone prophylaxis in neutropenic patients.