Antibiotic Prophylaxis with Quinolones in Afebrile Neutropenic Patients: Is there Enough Evidence for Mortality Effect?

Glaucia Fernandes Cota*, 1, 2, 3, Tatiani Fereguetti2, Marcos Roberto de Sousa1, 4
1 Clinics Hospital from Federal University of Minas Gerais – UFMG, Brazil
2 Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais – FHEMIG, Brazil
3 Post Graduation Program of Health Sciences at Rene Rachou Institute – Fundação Oswaldo Cruz (FIOCRUZ), Brazil
4 Post Graduation Program in Adult Health Sciences at Medical School from Federal University of Minas Gerais – UFMG, Belo Horizonte, Minas Gerais, Brazil

© 2012 Fernandes Cota et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: * Address correspondence to this author at the Avenida do Contorno, 9636/1607, Belo Horizonte, ZIP-CODE 30110-068, MG, Brazil. Tel/Fax: + 55 31 3295-6695; E-mail:


Febrile neutropenia causes significant morbidity and mortality in patients receiving antineoplastic chemotherapy. During the last decade, some trials have shown reduction in febrile episodes and bacteraemia with antibiotic prophylaxis. On the other hand, the emergence of fluoroquinolone-resistant bacteria in units practicing quinolones prophylaxis has been described and there is justified concern about the implications of this fact. Recent published guidelines now recommend quinolones prophylaxis for patients with neutropenia expected to last as least 7 days. They are based in a meta-analysis of placebo-controlled or no treatment-controlled trials of quinolone prophylaxis, which demonstrated risk reduction in mortality among drug treated recipients. In contrast, previous meta-analyses and the two major trials with two thirds of the number of patients of the largest meta-analysis failed to show this survival advantage. Using two sensitive tests, Egger's and Trim and Fill methods, we found a “small study effect” which acts exaggerating and making the result positive when they are probably neutral. In spite of the considerable number of trials and reviews involving prophylactic antibiotics for neutropenic patients, available evidence is hypothesis generator but not sufficient to state there is mortality benefit.

Keywords: Antibiotic prophylaxis, mortality, neutropenia, quinolones.