van de Wetering, M.D., de Witte, M.A., Kremer, L.C., Offringa, M., Scholten, R.J., & Caron, H.N. (2005). Efficacy of oral prophylactic antibiotics in neutropenic afebrile oncology patients: A systematic review of randomized controlled trials. European Journal of Cancer, 41, 1372–1382.

To compare oral-based prophylactic antibiotics (quinolone-based prophylaxis or trimethoprim/sulfamethoxazole (TMP/SMZ)-based regimens) with placebo or no prophylaxis. Trials considering patients with cancer (both adults and children) undergoing chemotherapy in which oral prophylactic antibiotics were started before the expected onset of neutropenia were included.

DATABASES USED: MEDLINE from 1966–October 2002, EMBASE from 1988–October 2002, and the Cochrane Central Register of Controlled Trials, issue 2, 2002; the references were checked for additional articles. Authors of included papers were contacted.

• FINAL NUMBER STUDIES INCLUDED = 22 randomized trials
• KEY SAMPLE CHARACTERISTICS: Patients with cancer undergoing chemotherapy

Antibacterial prophylaxis (TMP/SMZ or quinolones) significantly reduced bacteremia by 57% and infection-related mortality. Quinolones significantly reduced the risk of gram-negative bacteremia, but TMP/SMZ did not. TMP/SMZ significantly reduced the risk of gram-positive bacteremia, but quinolones did not. No significant increase was reported in the risk of fungemia or fungal-related mortality with antibacterial prophylaxis. In subgroup analyses, a significant reduction was found in bacteremia in patients undergoing conventional chemotherapy and bone and marrow transplantation.