Prophylactic antibiotics or G‐CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy
Abstract
Background
Febrile neutropenia (FN) and other infectious complications are some of the most serious treatment‐related toxicities of chemotherapy for cancer, with a mortality rate of 2% to 21%. The two main types of prophylactic regimens are granulocyte (G‐CSF) or granulocyte‐macrophage colony stimulating factors (GM‐CSF); and antibiotics, frequently quinolones or cotrimoxazole. Important current guidelines recommend the use of colony stimulating factors when the risk of febrile neutropenia is above 20% but they do not mention the use of antibiotics. However, both regimens have been shown to reduce the incidence of infections. Since no systematic review has compared the two regimens, a systematic review was undertaken.
Objectives
To compare the effectiveness of G‐CSF or GM‐CSF with antibiotics in cancer patients receiving myeloablative chemotherapy with respect to preventing fever, febrile neutropenia, infection, infection‐related mortality, early mortality and improving quality of life.
Search methods
We searched The Cochrane Library, MEDLINE, EMBASE, databases of ongoing trials, and conference proceedings of the American Society of Clinical Oncology and the American Society of Hematology (1980 to 2007). We planned to include both full‐text and abstract publications.
Selection criteria
Randomised controlled trials comparing prophylaxis with G‐CSF or GM‐CSF versus antibiotics in cancer patients of all ages receiving chemotherapy or bone marrow or stem cell transplantation were included for review. Both study arms had to receive identical chemotherapy regimes and other supportive care.
Data collection and analysis
Trial eligibility and quality assessment, data extraction and analysis were done in duplicate. Authors were contacted to obtain missing data.
Main results
We included two eligible randomised controlled trials with 195 patients. Due to differences in the outcomes reported, the trials could not be pooled for meta‐analysis. Both trials showed non‐significant results favouring antibiotics for the prevention of fever or hospitalisation for febrile neutropenia.
Authors' conclusions
There is no evidence for or against antibiotics compared to G(M)‐CSFs for the prevention of infections in cancer patients.
PICOs
Plain language summary
Prophylactic antibiotics or G‐CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy
Cancer treatment with chemotherapy (anti‐cancer drugs) or bone marrow or stem cell transplantation disrupts the immune system and lowers white blood cell counts. This increases a person's risk of infection. Both granulocyte colony stimulating factors (GSF) and antibiotics can reduce the risk of infection associated with cancer treatments. The review compared the effectiveness of antibiotics to GSFs for the prevention of infection and death. Only two studies were found that compared the two methods of prophylaxis. The studies could not be pooled but both showed a non‐significant trend towards a reduction of infection or fever in patients receiving antibiotics. More research is needed to determine the best prophylaxis against infection in cancer patients.
