Efficacy of fluoroquinolone prophylaxis in high-risk neutropenic patients with haematological malignancies: a systematic review with meta-analysis
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 12,586 participants or records.
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