Efficacy of fluoroquinolone prophylaxis in high-risk neutropenic patients with haematological malignancies: a systematic review with meta-analysis

Abstract Objectives To compare the clinical and microbiological outcomes of high-risk neutropenic patients receiving or not fluoroquinolone prophylaxis. Study eligibility criteria Randomized controlled trials (RCTs) and observational studies investigating overall mortality and rate of febrile episodes, of bloodstream infections and of isolation of a fluoroquinolone-resistant strain among patients receiving or not prophylaxis. Participants Patients with high-risk neutropenia due to haematological malignancies. Interventions Prophylaxis with either ciprofloxacin or levofloxacin. Comparator No prophylaxis. Methods of data synthesis We conducted a meta-analysis pooling risk ratios (RRs) through random effect models. Results Among 1731 articles screened, 18 original studies fulfilled the inclusion criteria and were included in the analysis, accounting for a total of 12,586 patients, 7157 (56.9%) of which receiving fluoroquinolones prophylaxis. The analysis assessing the primary outcome including 12,134 patients showed similar mortality rates between groups (RR 1.04, 95% CI 0.79–1.37, p = 0.77), with a low statistical heterogeneity observed (I 2 49.4%, p = 0.022). These findings were confirmed (RR 1.16, 95% CI 0.89–1.50, p = 0.27) in the sub-analysis excluding studies conducted in settings with low prevalence of fluoroquinolone resistance, on a total of 3121 patients, and a low heterogeneity was observed (I 2 27.6%, p = 0.18). Regarding the incidence of febrile episodes, a lower rate was observed among the 1701 patients receiving prophylaxis as compared to the 1514 not receiving prophylaxis (RR 0.87, 95% CI 0.88–0.96, p = 0.006); similarly, a lower rate of bloodstream infections was demonstrated among subjects receiving fluoroquinolone prophylaxis (RR 0.59, 95% CI 0.47–0.75, p < 0.001) in a meta-analysis including 11,681 patients. Finally, no difference in the isolation rate of fluoroquinolone resistant strains was observed (RR 0.87, 95% CI 0.34–2.20, p = 0.77) among 1481 patients included. Conclusions Our data suggest that fluoroquinolone prophylaxis in high-risk neutropenic patients is associated with a reduction in the incidence of febrile episodes and bacteraemia but does not provide a survival benefit.