Cruciani, M., Malena, M., Bosco, O., Nardi, S., Serpelloni, G., & Mengoli, C. (2003). Reappraisal with meta-analysis of the addition of gram-positive prophylaxis to fluoroquinolone in neutropenic patients. Journal of Clinical Oncology, 21, 4127–4137.

To compare prophylaxis with a fluoroquinolone (ciprofloxacin, ofloxacin, perfloxacin, or norfloxacin) in combination with an antibiotic against gram-positive bacteria (penicillins, macrolide, rifampin, or vancomycin) compared to fluoroquinolone alone in neutropenic patients with cancer

DATABASES USED: MEDLINE, CANCERLIT, Database of Abstracts of Reviews of Effects, and Cochrane Library (1984–2002); the bibliographies of retrieved studies also were reviewed.

• FINAL NUMBER STUDIES INCLUDED = 9 RCTs
• TOTAL PATIENTS INCLUDED IN REVIEW: 1,202
• KEY SAMPLE CHARACTERISTICS: Neutropenic patients with cancer

The addition of gram-positive prophylaxis to fluoroquinolones reduced

• Total episodes of bacteremia by 11.1%
• Staphylococcal and streptococcal infections
• Febrile morbidity by 6.7%.

No difference was found between gram-positive prophylaxis and a fluoroquinolone compared with a fluoroquinolone alone with regard to

• Clinically documented infections
• Gram-negative infections
• Unexplained episodes of fever
• Infectious mortality.

However, adding gram-positive prophylaxis significantly increased the occurrence of side effects, primarily gastrointestinal intolerance and liver function test abnormalities seen with rifampin and roxithromycin.

The authors concluded that the evidence does not support routine use of gram-positive coverage in combination with a fluoroquinolone for antibacterial prophylaxis in neutropenic patients with cancer.