Engels, E.A., Lau, J., & Barza, M. (1998). Efficacy of quinolone prophylaxis in neutropenic cancer patients: A meta-analysis. Journal of Clinical Oncology, 16, 1179–1187.

DATABASES USED: MEDLINE (1966–1996); the reference lists of retrieved articles also were reviewed.

• FINAL NUMBER STUDIES INCLUDED = 18 RCTs
• TOTAL PATIENTS INCLUDED IN REVIEW: 707
• KEY SAMPLE CHARACTERISTICS: Patients were undergoing chemotherapy for malignancy (primarily hematologic malignancies). Quinolone prophylaxis was compared with placebo (nine trials) or trimethoprim/sulfamethoxazole (nine trials). The article did not state whether patients received granulocyte colony-stimulating factors.

Without prophylaxis

• 82% of patients developed fever.
• 25% of patients developed gram-negative infections.
• 23% of patients developed gram-positive infections.
• 55% of patients developed any infection.

Compared with no prophylaxis, quinolone prophylaxis decreased the risk of

• Gram-negative infections by 79%
• Gram-negative bacteremia by 77%
• Microbiologically documented infections by 35%
• Total infections by 46%
• Fever by 15%.

Compared with trimethoprim/sulfamethoxazole prophylaxis, quinolone prophylaxis decreased the risk of

• Gram-negative infections by 70%
• Gram-negative bacteremia by 68%
• Microbiologically documented infections by 28%
• Total infections by 17%.

Quinolone prophylaxis did not affect the rate of

• Gram-positive infection or bacteremia
• Fungal infection
• Clinically documented infection
• Infection-related death.

The rate of quinolone-resistant gram-negative infections was 3.0%, and the rate of quinolone-resistant gram-positive infections was 9.4% among patients who received quinolone prophylaxis, but no data were provided regarding the rate of quinolone-resistant infections among the control group. Therefore, the effect of quinolone prophylaxis on the rate of quinolone-resistant infections is unknown.