Antibacterial prophylaxis in patients with neutropenia

Brahm H. Segal, Alison Gail Freifeld

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

Patients with cancer and chemotherapy-induced neutropenia are at risk for severe bacterial infections. This risk is not uniform among all cancer patients but is dependent primarily on the depth and duration of neutropenia and the type of underlying disease. Accordingly, the decision whether to use antibacterial prophylaxis to prevent serious infections in these patients requires a balance between expected benefit and the risks for infection, adverse drug-related events, and emergence of antibiotic resistance. Although antibacterial prophylaxis has the potential to benefit all patients with chemotherapy-induced neutropenia, the benefit regarding reduction in documented infections has been firmly established only in patients with neutropenia expected to exceed 7 days. A recent meta-analysis showed enhanced survival in patients receiving antibacterial prophylaxis during neutropenia; most patients enrolled in the analyzed trials had a hematologic malignancy. Among patients with neutropenia at lower risk for infectious complications (a category that includes most patients with solid tumor malignancies), the main benefit of antibacterial prophylaxis relates to a reduction in fever rather than documented infections. The authors advise quinolone prophylaxis (levofloxacin is preferred), in patients with an expected duration of neutropenia (absolute neutrophil count < 1000/μL) of more than 7 days. Trimethoprim-sulfamethoxazole should be used in patients at risk for Pneumocystis jiroveci (formerly P carinii), such as childhood acute lymphoblastic leukemia. In patients with neutropenia expected to last 7 days or less and not receiving immunosuppressive regimens (e.g., systemic corticosteroids), the authors recommend no initial prophylaxis. However, if such patients develop fever during neutropenia, they should be considered for outpatient empiric therapy with an oral quinolone-containing regimen if they meet criteria for low risk for complications.

Original languageEnglish (US)
Pages (from-to)235-242
Number of pages8
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume5
Issue number2
DOIs
StatePublished - Feb 2007

Fingerprint

Neutropenia
Quinolones
Infection
Neoplasms
Fever
Pneumocystis carinii
Drug Therapy
Levofloxacin
Sulfamethoxazole Drug Combination Trimethoprim
Hematologic Neoplasms
Immunosuppressive Agents
Microbial Drug Resistance
Drug-Related Side Effects and Adverse Reactions
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bacterial Infections
Meta-Analysis
Adrenal Cortex Hormones
Neutrophils
Outpatients

Keywords

  • Empirical therapy
  • Fever
  • Neutropenia
  • Prophylaxis
  • Quinolone
  • TMP-STX

ASJC Scopus subject areas

  • Oncology

Cite this

Antibacterial prophylaxis in patients with neutropenia. / Segal, Brahm H.; Freifeld, Alison Gail.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 5, No. 2, 02.2007, p. 235-242.

Research output: Contribution to journalReview article

@article{a84da411466b42c88817a32adbe018c1,
title = "Antibacterial prophylaxis in patients with neutropenia",
abstract = "Patients with cancer and chemotherapy-induced neutropenia are at risk for severe bacterial infections. This risk is not uniform among all cancer patients but is dependent primarily on the depth and duration of neutropenia and the type of underlying disease. Accordingly, the decision whether to use antibacterial prophylaxis to prevent serious infections in these patients requires a balance between expected benefit and the risks for infection, adverse drug-related events, and emergence of antibiotic resistance. Although antibacterial prophylaxis has the potential to benefit all patients with chemotherapy-induced neutropenia, the benefit regarding reduction in documented infections has been firmly established only in patients with neutropenia expected to exceed 7 days. A recent meta-analysis showed enhanced survival in patients receiving antibacterial prophylaxis during neutropenia; most patients enrolled in the analyzed trials had a hematologic malignancy. Among patients with neutropenia at lower risk for infectious complications (a category that includes most patients with solid tumor malignancies), the main benefit of antibacterial prophylaxis relates to a reduction in fever rather than documented infections. The authors advise quinolone prophylaxis (levofloxacin is preferred), in patients with an expected duration of neutropenia (absolute neutrophil count < 1000/μL) of more than 7 days. Trimethoprim-sulfamethoxazole should be used in patients at risk for Pneumocystis jiroveci (formerly P carinii), such as childhood acute lymphoblastic leukemia. In patients with neutropenia expected to last 7 days or less and not receiving immunosuppressive regimens (e.g., systemic corticosteroids), the authors recommend no initial prophylaxis. However, if such patients develop fever during neutropenia, they should be considered for outpatient empiric therapy with an oral quinolone-containing regimen if they meet criteria for low risk for complications.",
keywords = "Empirical therapy, Fever, Neutropenia, Prophylaxis, Quinolone, TMP-STX",
author = "Segal, {Brahm H.} and Freifeld, {Alison Gail}",
year = "2007",
month = "2",
doi = "10.6004/jnccn.2007.0023",
language = "English (US)",
volume = "5",
pages = "235--242",
journal = "JNCCN Journal of the National Comprehensive Cancer Network",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "2",

}

TY - JOUR

T1 - Antibacterial prophylaxis in patients with neutropenia

AU - Segal, Brahm H.

AU - Freifeld, Alison Gail

PY - 2007/2

Y1 - 2007/2

N2 - Patients with cancer and chemotherapy-induced neutropenia are at risk for severe bacterial infections. This risk is not uniform among all cancer patients but is dependent primarily on the depth and duration of neutropenia and the type of underlying disease. Accordingly, the decision whether to use antibacterial prophylaxis to prevent serious infections in these patients requires a balance between expected benefit and the risks for infection, adverse drug-related events, and emergence of antibiotic resistance. Although antibacterial prophylaxis has the potential to benefit all patients with chemotherapy-induced neutropenia, the benefit regarding reduction in documented infections has been firmly established only in patients with neutropenia expected to exceed 7 days. A recent meta-analysis showed enhanced survival in patients receiving antibacterial prophylaxis during neutropenia; most patients enrolled in the analyzed trials had a hematologic malignancy. Among patients with neutropenia at lower risk for infectious complications (a category that includes most patients with solid tumor malignancies), the main benefit of antibacterial prophylaxis relates to a reduction in fever rather than documented infections. The authors advise quinolone prophylaxis (levofloxacin is preferred), in patients with an expected duration of neutropenia (absolute neutrophil count < 1000/μL) of more than 7 days. Trimethoprim-sulfamethoxazole should be used in patients at risk for Pneumocystis jiroveci (formerly P carinii), such as childhood acute lymphoblastic leukemia. In patients with neutropenia expected to last 7 days or less and not receiving immunosuppressive regimens (e.g., systemic corticosteroids), the authors recommend no initial prophylaxis. However, if such patients develop fever during neutropenia, they should be considered for outpatient empiric therapy with an oral quinolone-containing regimen if they meet criteria for low risk for complications.

AB - Patients with cancer and chemotherapy-induced neutropenia are at risk for severe bacterial infections. This risk is not uniform among all cancer patients but is dependent primarily on the depth and duration of neutropenia and the type of underlying disease. Accordingly, the decision whether to use antibacterial prophylaxis to prevent serious infections in these patients requires a balance between expected benefit and the risks for infection, adverse drug-related events, and emergence of antibiotic resistance. Although antibacterial prophylaxis has the potential to benefit all patients with chemotherapy-induced neutropenia, the benefit regarding reduction in documented infections has been firmly established only in patients with neutropenia expected to exceed 7 days. A recent meta-analysis showed enhanced survival in patients receiving antibacterial prophylaxis during neutropenia; most patients enrolled in the analyzed trials had a hematologic malignancy. Among patients with neutropenia at lower risk for infectious complications (a category that includes most patients with solid tumor malignancies), the main benefit of antibacterial prophylaxis relates to a reduction in fever rather than documented infections. The authors advise quinolone prophylaxis (levofloxacin is preferred), in patients with an expected duration of neutropenia (absolute neutrophil count < 1000/μL) of more than 7 days. Trimethoprim-sulfamethoxazole should be used in patients at risk for Pneumocystis jiroveci (formerly P carinii), such as childhood acute lymphoblastic leukemia. In patients with neutropenia expected to last 7 days or less and not receiving immunosuppressive regimens (e.g., systemic corticosteroids), the authors recommend no initial prophylaxis. However, if such patients develop fever during neutropenia, they should be considered for outpatient empiric therapy with an oral quinolone-containing regimen if they meet criteria for low risk for complications.

KW - Empirical therapy

KW - Fever

KW - Neutropenia

KW - Prophylaxis

KW - Quinolone

KW - TMP-STX

UR - http://www.scopus.com/inward/record.url?scp=33947260022&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947260022&partnerID=8YFLogxK

U2 - 10.6004/jnccn.2007.0023

DO - 10.6004/jnccn.2007.0023

M3 - Review article

C2 - 17335692

AN - SCOPUS:33947260022

VL - 5

SP - 235

EP - 242

JO - JNCCN Journal of the National Comprehensive Cancer Network

JF - JNCCN Journal of the National Comprehensive Cancer Network

SN - 1540-1405

IS - 2

ER -