OBJECTIVES: Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. METHODS: Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. RESULTS: Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. CONCLUSIONS: The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.

Department of Epidemiology Biostatistics and Clinical Trials Ospedale Policlinico San Martino Genoa Italy

Department of Haematology Henri Mondor Teaching Hospital Assistance Publique hôpitaux de Paris and Université Paris Est Créteil Créteil France

Division of Infectious Diseases University of Genoa and Ospedale Policlinico San Martino Genoa Italy

Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology Ankara Turkey

Infectious Diseases Service Centre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland

Infectious Diseases Service Department of Medicine Centre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland

Pediatric Infectious Diseases Hadassah Hebrew University Medical Center Jerusalem Israel

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