Adding Gram-positive prophylaxis to
ﬂuoroquinolone regimens reduces streptococcal
bacteraemias, but prophylaxis remains
Abstracted from: Cruciani M, Malena M, Bosco O, et al. Reappraisal with meta-analysis of the addition of
gram-positive prophylaxis to ﬂuoroquinolone in neutropenic patients. Journal of Clinical Oncology
It is well established that ﬂuoroquinolones are ef-
fective at preventing Gram-negative infection in
people undergoing chemotherapy for cancer who
are neutropenic. However, Gram-positive infection
has now emerged as the most common infection in
neutropenic people receiving ﬂuoroquinolones. It
is yet to be determined if adding antimicrobial
agents with Gram-positive activity to prophylactic
ﬂuoroquinolone-based regimens improves clinical
To compare the clinical effectiveness of adding an-
tibiotics with Gram-positive activity to prophylactic
ﬂuoroquinolone-based regimens, in granulocytope-
nic people undergoing chemotherapy for cancer.
Systematic review with meta-analysis.
MEDLINE, CancerLIT, DARE, and the Cochrane Li-
brary were searched from 1984 to October 2002.
Bibliographies were hand-searched and authors
contacted for missing or incomplete information.
All randomised controlled trials (RCTs) comparing
prophylactic ﬂuoroquinolone-based regimens plus
antibiotics with Gram-positive activity versus ﬂu-
oroquinolone-based regimes alone in granulocy-
topenic people undergoing chemotherapy for
cancer were included.
Primary outcomes were bacteraemic episodes;
Gram-positive and Gram-negative infections; fe-
brile morbidity; mortality and adverse effects of
9 RCTs (1202 people) met inclusion criteria. Par-
ticipants were diagnosed with: acute lymphoma,
and received bone marrow transplant ([BMT], 2
RCTs, n ¼ 184); acute lymphoma or lymphoma,
received BMT (2 RCTs, n ¼ 192); acute lymphoma,
lymphoma, or solid tumour, received BMT (3 RCTs,
n ¼ 663); solid tumour – mainly breast cancer,
received high-dose chemotherapy and peripheral
blood stem cell transplantation (2 RCTs, n ¼ 163).
All participants had severe neutropenia (neutrophil
counts ranged from <500 to <1000 per lL; mean
number of days with neutropenia ranged from 8 to
30 days.) Participants received oral norﬂoxacin
(one study), oﬂoxacin (two studies), peﬂoxacin
0305-7372/$ - see front matter
2004 Elsevier Ltd. All rights reserved.
CANCER TREATMENT REVIEWS (2004) 30, 385–388