Ghadiany, M., Rahimi, H., Rezvani, H., Mohammad Alizadeh, A., Zamani, N., Mehdizadeh, M., & Foratyazdi, M. (2016). Prophylaxis of neutropenic fever with ciprofloxacin in patients with acute myeloid leukemia treated with intensive chemotherapy. Asia-Pacific Journal of Clinical Oncology, 12, e11–e15.

To compare outcomes between patients with acute myeloid leukemia (AML) who did or did not receive prophylactic ciprofloxacin 500 mg twice per day for neutropenic fever

Administration of prophylactic ciprofloxacin 500 mg twice daily for the prevention of neutropenic fever

• N = 69   
• MEAN AGE = 41.3 years (SD = 14.3) ciprofloxacin group, 37.4 years (SD = 9) non-ciprofloxacin group
• MALES: 68.1%, FEMALES: 31.9%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: AML as diagnosed by bone marrow and peripheral blood smear showing greater than 20% blasts and meeting AML criteria on flow cytometry analysis (criteria for flow cytometry indications of AML not specified)
• OTHER KEY SAMPLE CHARACTERISTICS: Patients native to Tehran who had been treated from September 2009 to November 2010 for AML with idarubicin 12 mg/m²/day for three days and Ara-C 100–200 mg/m²/day as a continuous infusion for seven days were included.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Tehran, Iran

PHASE OF CARE: Active antitumor treatment

Retrospective, medical record, cross-sectional evaluation

Outcome measurements included rate of neutropenic fever episodes, microbiologic findings, patterns of resistance, and mortality. Independent variables included demographic data, type of AML, and administration or absence of the intervention (prophylactic ciprofloxacin). Administration of granulocyte–colony-stimulating factors were also included in the analyses.

No statistically significant differences were found in any of the outcome variables between patients who received prophylactic ciprofloxacin compared to patients who did not receive the prophylactic treatment. Specifically 80% of the treatment group and 82% of the control had neutropenic fevers. Although mortality rates were lower among those who received the prophylactic ciprofloxacin compared to those who did not, the differences were not statistically significant.

There is no benefit of prophylactic ciprofloxacin for the prevention of neutropenic fever among patients undergoing induction chemotherapy for AML. These findings aligned with other similar studies with the exception of one that the researchers found in the literature.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Findings not generalizable

Understanding the ineffectiveness of prophylactic ciprofloxacin for the prevention of febrile neutropenia in patients undergoing induction chemotherapy for AML can aid in treatment decisions and promote the use of more effective interventions.