Fluoroquinolone prophylaxis in patients with neutropenia at high risk of serious infections: Exploring pros and cons

Singh, N; Thursky, K; Maron, G; Wolf, J

Author(s): Singh, N; Thursky, K; Maron, G; Wolf, J;
Details: Publication Year 2023-09-25,Volume 25,Issue #Suppl 1,Page e14152
Journal Title: Transplant Infectious Disease
Publication Type: Review
Abstract: BACKGROUND: The use of fluoroquinolones to prevent infections in neutropenic patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT) is a controversial issue, with international guidelines providing conflicting recommendations. Although potential benefits are clear, concerns revolve around efficacy, potential harms, and antimicrobial resistance (AMR) implications. DISCUSSION: Fluoroquinolone prophylaxis reduces neutropenic fever (NF) bloodstream infections and other serious bacterial infections, based on evidence from systematic reviews, randomized controlled trials, and observational studies in adults and children. Fluoroquinolone prophylaxis may also reduce infection-related morbidity and healthcare costs; however, evidence is conflicting. Adverse effects of fluoroquinolones are well recognized in the general population; however, studies in the cancer cohort where it is used for a defined period of neutropenia have not reflected this. The largest concern for routine use of fluoroquinolone prophylaxis remains AMR, as many, but not all, observational studies have found that fluoroquinolone prophylaxis might increase the risk of AMR, and some studies have suggested negative impacts on patient outcomes as a result. CONCLUSIONS: The debate surrounding fluoroquinolone prophylaxis calls for individualized risk assessment based on patient characteristics and local AMR patterns, and prophylaxis should be restricted to patients at the highest risk of serious infection during the highest risk periods to ensure that the risk-benefit analysis is in favor of individual and community benefit. More research is needed to address important unanswered questions about fluoroquinolone prophylaxis in neutropenic patients with cancer or receiving HSCT.
Publisher: Wiley
Keywords: antimicrobial stewardship; antimicrobials; bone marrow transplantation; febrile neutropenia; fluoroquinolone; hematology; levofloxacin; neutropenic fever; oncology; prophylaxis
Department(s): Pharmacy; Health Services Research; Infectious Diseases; Infectious Diseases; Health Services Research
PubMed ID: 37746769
Publisher's Version: https://doi.org/10.1111/tid.14152
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-11-21 05:54:31

Last Modified: 2024-09-05 06:55:58