The Effectiveness of Levofloxacin in Prevention of Febrile Episodes in Non-Hodgkin Lymphoma Patients Receiving Rituximab, Cyclophosphamide, Vincristine, Doxorubicin and Prednisolone (R-CHOP)
Abstract
Background: Febrile neutropenia poses significant risks for morbidity and mortality in non-Hodgkin lymphoma (NHL) patients undergoing R-CHOP chemotherapy. Prophylactic antibacterial use after R-CHOP is controversial, especially when patients receive primary G-CSF prophylaxis, with no established standard recommendation. This study aims to evaluate the effectiveness of levofloxacin in preventing febrile episodes in NHL patients receiving R-CHOP and G-CSF prophylaxis.
Method: A randomized, single-blind, placebo-controlled trial was conducted at King Chulalongkorn Memorial Hospital, enrolling non-Hodgkin lymphoma patients undergoing R-CHOP chemotherapy from January 1, 2023, to June 30, 2024. Patients were randomly assigned to receive either levofloxacin 500 mg once daily or a matching placebo for 7 days, beginning one day after chemotherapy. All patients received primary G-CSF prophylaxis. The primary outcome was the occurrence of febrile episodes within 120 days. Secondary outcomes included rates of septic shock, septic death, all-cause mortality, chemotherapy dose reduction, and the onset of the first febrile episode and composite outcome.
Results: Eighty participants were randomly assigned to two groups, with 40 individuals in each group. Their mean age was 61 years. In the intention-to-treat analysis, febrile episodes occurred in 7.5% and 30% of participants in the levofloxacin and placebo groups, respectively (P = 0.010). Levofloxacin prophylaxis significantly reduced…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 40 participants or records.
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