Original Article
Antibacterial Prophylaxis after Chemotherapy for Solid Tumors and Lymphomas
N Engl J Med 2005; 353:988-998September 8, 2005
- Abstract
Background
The role of prophylactic antibacterial agents after chemotherapy remains controversial.
Methods
We conducted a randomized, double-blind, placebo-controlled trial in patients who were receiving cyclic chemotherapy for solid tumors or lymphoma and who were at risk for temporary, severe neutropenia (fewer than 500 neutrophils per cubic millimeter). Patients were randomly assigned to receive either 500 mg of levofloxacin once daily or matching placebo for seven days during the expected neutropenic period. The primary outcome was the incidence of clinically documented febrile episodes (temperature of more than 38°C) attributed to infection. Secondary outcomes included the incidence of all probable infections, severe infections, and hospitalization but did not include a systematic evaluation of antibacterial resistance.
Results
A total of 1565 patients underwent randomization (784 to placebo and 781 to levofloxacin). The tumors included breast cancer (35.4 percent), lung cancer (22.5 percent), testicular cancer (14.4 percent), and lymphoma (12.8 percent). During the first cycle of chemotherapy, 3.5 percent of patients in the levofloxacin group had at least one febrile episode, as compared with 7.9 percent in the placebo group (P<0.001). During the entire chemotherapy course, 10.8 percent of patients in the levofloxacin group had at least one febrile episode, as compared with 15.2 percent of patients in the placebo group (P=0.01); the respective rates of probable infection were 34.2 percent and 41.5 percent (P=0.004). Hospitalization was required for the treatment of infection in 15.7 percent of patients in the levofloxacin group and 21.6 percent of patients in the placebo group (P=0.004). The respective rate of severe infection was 1.0 percent and 2.0 percent (P=0.15), with four infection-related deaths in each group. An organism was isolated in 9.2 percent of probable infections.
Conclusions
Among patients receiving chemotherapy for solid tumors or lymphoma, the prophylactic use of levofloxacin reduces the incidence of fever, probable infection, and hospitalization.
Media in This Article
Figure 1
Enrollment and Outcomes.Table 1
Baseline Characteristics of the Patients.Article Activity
- Article
Bacterial infections among patients receiving myelosuppressive chemotherapy for solid cancers and lymphomas lead to complications, hospitalization, the use of major resources,1 delays and dose reductions in chemotherapy regimens,2 and in some cases, death. Guidelines have generally advised against the routine use of antibiotics for prophylaxis,3-5 but a recent survey of 3600 physicians in the United States revealed that 45 percent routinely use fluoroquinolone prophylaxis in patients receiving chemotherapy.6 Uncertainty about the prophylactic use of antibiotics continues despite decades of controversy and investigation.7,8 Meta-analysis of nine trials (involving 731 patients) comparing fluoroquinolone prophylaxis with no prophylaxis demonstrated significant reductions in a number of outcomes of infection.9 However, when blinded trials alone were analyzed, there was no reduction in the incidence of fever, and seven trials did not analyze data on an intention-to-treat basis. Finally, most trials focused on in-patient care of patients with leukemia; patients with solid tumors who were receiving standard-dose chemotherapy were included in only three of the nine trials.
Meta-analyses have indicated that fluoroquinolones are more likely than trimethoprim–sulfamethoxazole to have prophylactic efficacy and that the addition of a penicillin or macrolide antibiotic does not further reduce the incidence of febrile episodes.9,10 Levofloxacin is an agent with an acceptable side-effect profile that is administered once daily, thus optimizing compliance, a major issue in prophylaxis. It is active against a wide range of gram-negative pathogens, as well as some gram-positive bacteria and organisms causing atypical pneumonias.11 We conducted a large, randomized, double-blind, placebo-controlled trial designed to determine the efficacy of an empirical strategy, offering seven days' prophylaxis with levofloxacin during the period of anticipated neutropenia in patients with solid cancers or lymphomas who were considered at risk for infection during cyclic, myelosuppressive chemotherapy.
Methods
Patients
Oncology or hematology specialists throughout the United Kingdom who were treating patients for cancer were invited to participate in the trial. Adults (defined as those at least 16 years of age) commencing cytotoxic chemotherapy for solid tumors or lymphoma and at risk for bacterial infection were randomly assigned to receive levofloxacin or matching placebo for seven days to cover the period of anticipated neutropenia. The protocol listed widely used chemotherapy regimens and doses associated with a known risk of cyclic severe neutropenia (fewer than 500 neutrophils per cubic millimeter) but that were not routinely given with granulocyte colony-stimulating factor (G-CSF) or stem-cell support. Patients remained enrolled in the trial for up to six cycles of chemotherapy. A cycle of chemotherapy was defined as the standard, minimal duration of a particular regimen between the start of one treatment and the next that was sufficient to allow recovery from acute adverse effects, including myelosuppression. Exclusion criteria at the time of randomization were active infection, current antibacterial therapy, planned use of G-CSF, a history of adverse reactions to fluoroquinolones, epilepsy, a creatinine clearance below 40 ml per minute, pregnancy, and breast-feeding.
All patients gave written informed consent, and the research was approved by the ethics committee of each participating institution. The commercial sponsor played no role in the design of the trial, recruitment, data collection, analysis, or writing of the manuscript.
Randomization
Randomization involved the use of a computerized minimization algorithm, which was developed and kept securely by the Cancer Research UK Clinical Trials Unit, Birmingham, and was accessed by participating investigators by means of the telephone. Patients were stratified according to age (less than 40 years, 40 to 59 years, or 60 years or older), the type of cancer (breast cancer, testicular cancer, small-cell lung cancer, non-Hodgkin's lymphoma, Hodgkin's disease, or other), and treatment center. The following baseline variables potentially related to the risk of infection were recorded at randomization: World Health Organization (WHO) performance status, adjuvant use of chemotherapy, presence of a long-term indwelling venous catheter, and previous myelosuppressive chemotherapy or previous radiotherapy likely to compromise bone marrow function.
Outcome Measures
The primary outcome measure was the incidence of clinically documented febrile episodes, defined by a core temperature exceeding 38°C, attributed to infection. The incidence of all probable infections was a secondary outcome measure. Probable infections were defined by at least one of the following: a clinically documented febrile episode; other signs attributed to a systemic response to infection, such as hypothermia (temperature below 35.6°C), low-grade fever (temperature, 37.5 to 37.9°C), tachycardia (more than 90 beats per minute), or tachypnea (more than 20 breaths per minute); signs of a focus of infection; or the use of antibacterial therapy. Physicians were required to report episodes that occurred during each chemotherapy cycle or within four weeks after the final cycle. The incidence of hospitalization for infection and the frequency of severe infection were further secondary outcome measures. Severe infections were defined by the presence of infection-related sepsis syndrome (i.e., infection causing hypotension with or without evidence of impaired organ perfusion), death from infection, or both.
Additional secondary outcomes included the site of infection and the neutrophil count at the onset of infection. Microbiologic outcomes included causative organisms isolated during infection. The clinical significance of isolates was assessed by a microbiologist who was unaware of patients' treatment assignments.
On the diagnosis of an episode of infection, patients were evaluated and treated according to clinical findings and local policy. Study medication was withdrawn for that cycle alone, but patients could remain in the trial for subsequent cycles if blinding had been maintained.
Trial Medication
Trial medication consisted of 500-mg tablets of levofloxacin or matching placebo, supplied in single-use packs sufficient for six cycles and identified only by a unique number. The tablets were dispensed one cycle at a time to be taken once daily for seven consecutive days just before and during the anticipated period of neutropenia. Treatment began on day 8 for 14-day and 21-day cycles, on day 5 for regimens associated with an early onset of neutropenia (e.g., docetaxel), and on day 15 for 28-day cycles. To facilitate compliance monitoring, patients reported the number of tablets taken with each cycle, and the trial-medication bottles were returned to the pharmacies for pill counts after each cycle.
The host pharmacy was allowed to break the code in the event of a serious adverse event attributed to the study drug or a serious infection for which this knowledge was deemed essential to guide antibacterial therapy. Unblinding was not offered routinely in the event of a febrile episode. Instead, patients continued to take the assigned drug during subsequent cycles.
The study drug was permanently discontinued if the physician believed antibacterial prophylaxis was definitely indicated, if unblinding was required, or if an adverse event occurred that was attributed to the study drug and thus warranted its discontinuation. If the study drug was discontinued before the completion of the planned number of chemotherapy cycles, monitoring for outcome measures continued for up to six cycles to allow the inclusion of the patient in an intention-to-treat analysis.
Statistical Analysis
We estimated that we would need to enroll 1500 patients for the study to have a statistical power of 80 percent to detect a halving of the rate of febrile episodes in the first cycle in the levofloxacin group, as compared with the placebo group, and a power of 90 percent to detect a one-third reduction in the cumulative rate of febrile episodes during all cycles, given a significance level of 5 percent. Rates of febrile episodes, all probable infections (including febrile episodes), hospitalization for infection, and severe infections per patient were compared with the use of continuity-adjusted chi-square tests. The analysis was carried out on an intention-to-treat basis, with all patients included in their assigned treatment groups and the small numbers of patients with an unknown outcome (which were similar in the two groups) combined with those who had no events. A sensitivity analysis confirmed the validity of this assumption.
The relative differences between the treatment groups were expressed as relative risks with 95 percent confidence intervals. Data on secondary outcomes relating only to cycles with infection are presented descriptively.
Results
From August 1999 to April 2003, 1565 patients from 60 centers underwent randomization, 784 to placebo and 781 to levofloxacin (Figure 1Figure 1
Enrollment and Outcomes.). Three patients in each group were ineligible but were included in the intention-to-treat analysis. A total of 90.5 percent of patients had a WHO performance status of 0 or 1, and nearly half were treated in the adjuvant context. About one third of the patients had breast cancer, but substantial numbers were treated for testicular and small-cell lung cancers. The treatment groups were well balanced with respect to all baseline characteristics and risk factors (Table 1Table 1Baseline Characteristics of the Patients.). A total of 6869 cycles were analyzed. The number of cycles studied and the numbers of patients with missing data were similar in the two groups (Figure 1).Infection
Of the 1565 randomized patients, 203 (13.0 percent) had at least one febrile episode, and there were 248 febrile episodes in total (3.6 percent of cycles). At least 1 probable infection occurred in 592 patients (37.8 percent), and there were a total of 817 probable infections (11.9 percent of cycles) (Table 2Table 2
Characteristics of 817 Probable Infections among 6869 Cycles.).A clinically documented febrile episode occurred during the first chemotherapy cycle in 27 of 781 patients in the levofloxacin group (3.5 percent), as compared with 62 of 784 patients in the placebo group (7.9 percent) (Table 3Table 3
Incidence of Febrile Episodes, Probable Infections, and Hospitalization for Infection.). The relative risk of a clinically documented febrile episode was 0.44 (95 percent confidence interval, 0.28 to 0.68; P<0.001), indicating a 56 percent reduction in the risk of fever during the first cycle with the use of levofloxacin therapy, as compared with placebo. There was also a significant reduction in the incidence of the more inclusive category of probable infections with levofloxacin prophylaxis, as compared with placebo, resulting in a 28 percent reduction in the risk during the first cycle of chemotherapy (relative risk, 0.72; 95 percent confidence interval, 0.57 to 0.90; P=0.005).Events related to infection in individual patients during multiple cycles are not independent: patient factors, changes in treatment, and possible bacterial resistance resulting from antibacterial treatment in an earlier cycle may influence the risk of infection and the effect of prophylaxis in subsequent cycles. For this reason, data obtained during the entire chemotherapy course were analyzed per patient rather than per cycle, and levofloxacin was found to confer a protective benefit similar to that identified in the analysis of the first cycle (Table 3). During the entire course of chemotherapy, 84 of 781 patients in the levofloxacin group had a clinically documented febrile episode (10.8 percent), as compared with 119 of 784 patients in the placebo group (15.2 percent). Prophylactic levofloxacin was thus associated with a 29 percent relative reduction in the risk of a febrile episode (relative risk, 0.71; 95 percent confidence interval, 0.55 to 0.92; P=0.01) and an 18 percent relative reduction in the risk of probable infection (relative risk, 0.82; 95 percent confidence interval, 0.73 to 0.94; P=0.004). Only 36 patients (2.3 percent) had more than one febrile episode, but the incidence of multiple fevers was more than halved among those receiving levofloxacin, as compared with those receiving placebo (10 vs. 26).
Hospitalization for Infection
The reduction in the incidence of febrile episodes and probable infection associated with levofloxacin prophylaxis was reflected in a significant reduction in the percentage of patients hospitalized for infection (Table 3). There was a 36 percent reduction in the risk of hospitalization during cycle 1 with levofloxacin therapy, as compared with placebo (relative risk, 0.64; 95 percent confidence interval, 0.46 to 0.90; P=0.01), and a 27 percent reduction across all cycles (relative risk, 0.73; 95 percent confidence interval, 0.59 to 0.90; P=0.004).
Severe Infections
Severe infection, characterized by infection-related sepsis syndrome, death, or both, occurred in 8 patients in the levofloxacin group, as compared with 16 in the placebo group (1.0 percent vs. 2.0 percent, P=0.15); 4 patients died in each group. The eight severe infections in the levofloxacin group (including those resulting in the four deaths) occurred outside the period in which the white-cell count was expected to be lowest or when the patients were not taking levofloxacin (because of a failure to prescribe the drug, the discontinuation of levofloxacin therapy, or noncompliance with therapy). In comparison, 8 of the 16 severe infections in the placebo group, including those leading to three of four deaths, occurred during the expected nadir period while the patients were taking placebo.
Timing of Infections and Compliance
Patients took the study drug on all seven days in 71.7 percent of cycles, and the percentages were similar in the two groups (Table 4Table 4
Treatment Compliance, Adverse Events, and Characteristics of Febrile Episodes and Probable Infections.). A failure of prophylaxis was defined by the onset of a febrile episode during prophylaxis, with documented compliance up to the day of infection. In the levofloxacin group, 25.8 percent of febrile episodes (25 of 97) were considered failures of prophylaxis, as compared with 40.4 percent of such episodes in the placebo group (61 of 151) (Table 4).Microbiologic Outcomes
The organism that was the probable cause of the febrile episode or episode of probable infection was isolated less frequently among patients in the levofloxacin group than among patients in the placebo group (7.2 percent vs. 14.6 percent and 4.6 percent vs. 12.6 percent, respectively) (Table 4). Gram-negative organisms were isolated on 37 occasions. Of the 13 isolates for which data on fluoroquinolone susceptibility were available, 12 were sensitive; the 1 resistant organism was from a patient in the placebo group (see Table 1 and Table 2 of the Supplementary Appendix, available with the full text of this article at www.nejm.org). Of the eight probable instances of bacteremia in the levofloxacin group, three were regarded as the result of probable contaminants in the culture, two occurred outside the treatment period, and the other three occurred in patients who were not taking levofloxacin.
Adverse Events
Adverse events were reported in 118 of 6869 cycles of chemotherapy (1.7 percent). There was a slight excess of adverse events in the levofloxacin group, owing to a higher rate of minor gastrointestinal symptoms and rash (Table 4).
Discussion
We addressed the efficacy of antibacterial prophylaxis in patients treated for solid cancers with chemotherapy regimens associated with short periods of neutropenia and thus an increased risk of infection. A simple, clinically relevant objective observation (fever, as defined by a temperature of more than 38°C) attributed to infection was chosen as the primary outcome measure because, in routine practice, this finding often triggers urgent treatment of infection in patients who may have neutropenia. Microbiologic confirmation was not required to meet this end point, since it was assumed that such a stipulation would result in the underreporting of infections and that prophylaxis might interfere with culture results, causing bias. Our results confirm this supposition: organisms were isolated in only a minority of febrile episodes (11.7 percent) and probable infections (9.2 percent), and organisms were isolated more frequently from cultures in the placebo group than in the levofloxacin group (Table 4). It is possible that some true episodes of infection were not reported and that some reported events attributed to bacterial infection were, in reality, due to other causes (e.g., viral infection). The occurrence of either possibility would tend to decrease the sensitivity of the trial to detect a true prophylactic effect of levofloxacin. However, the randomized, double-blind, placebo-controlled design means that any diagnostic inaccuracies were independent of treatment allocation and should not have biased the results.
To maximize the collection of data for the clinical end point in this large, multicenter trial of outpatients, we chose not to collect extensive data on the antibacterial resistance of infecting or colonizing isolates. This is an important limitation. Antibacterial prophylaxis might select for microbial resistance, and conversely, resistance patterns may affect prophylactic efficacy. Many factors affect the incidence of bacterial resistance, but there is a long history of misuse of antibacterial agents,12 and a correlation between national levels of outpatient use of antibacterial agents and resistance has been demonstrated across Europe.13 The effect on the development of resistance with the repeated use of short periods of fluoroquinolone prophylaxis on an outpatient basis among patients receiving cytotoxic chemotherapy is unknown. One possible consequence would be increasing bacterial resistance. Alternatively, a reduction in the incidence of hospitalization and the use of broad-spectrum antibacterial agents in that setting might reduce selection pressure for bacterial resistance among patients with cancer. This large, randomized controlled trial was designed to show whether levofloxacin prophylaxis to reduce clinical infection is a rational approach in a defined group of at-risk patients. However, our results alone cannot be used to determine whether a policy of antibacterial prophylaxis should be applied systematically.
Thirteen percent of patients receiving conventional-dose chemotherapy for solid tumors or lymphoma had at least one febrile episode, with an overall incidence of 3.6 percent per cycle. During the entire course of chemotherapy, approximately one third fewer patients in the levofloxacin group than in the placebo group had a febrile episode (10.8 percent vs.15.2 percent). The incidence of fever during the first cycle of chemotherapy among the patients in the levofloxacin group was less than half that among patients in the placebo group (3.5 percent vs. 7.9 percent). Not all infections are characterized by fever; hence, the inclusion of the outcome of probable infection. This category is heterogeneous, more dependent on the interpretation of clinical data by the physician, and more likely to include events that cannot be prevented by antibacterial prophylaxis. Thus, a smaller proportion of these events than of febrile episodes was associated with a neutrophil count of less than 100 per cubic millimeter. Levofloxacin prophylaxis was still associated with a significant reduction in the overall risk of probable infections. The overall incidence of severe infections was just 1.5 percent, and although the incidence was 50 percent lower with levofloxacin than with placebo, the trial was not powered statistically to detect the ability of prophylaxis to prevent severe infection or death from infection. The reduction in the incidence of hospitalization for the treatment of infection was significant and equivalent to a saving of about 38 hospital days per 100 patients given levofloxacin prophylaxis. Forty percent of fevers occurred outside the expected period of neutropenia (i.e., the period of prophylaxis) (Table 4). This finding calls into question the optimal timing and duration of prophylaxis. All severe infections and deaths from infection in the levofloxacin group occurred either outside the period of prophylaxis or among patients who were not taking the study drug. This finding emphasizes the importance of compliance.
A trial conducted by the European Organisation for Research and Treatment of Cancer14 randomly assigned 163 patients with small-cell lung cancer to receive ciprofloxacin plus roxithromycin or placebo alone for 10 days after chemotherapy. The group that received prophylaxis had a marked reduction in infection-related outcomes, including death, particularly in a cohort receiving intensified chemotherapy with G-CSF. We extend these findings, reporting a significant benefit from single-agent prophylaxis for seven days in a much larger cohort of patients with a wide spectrum of cancers and treatments, including 220 patients who received nonintensified chemotherapy for small-cell lung cancer with no G-CSF.
There is more than one strategy for using the limited repertoire of orally bioavailable antibacterial agents to combat neutropenic infection. Instead of routine prophylaxis, fluoroquinolones might be used empirically to treat neutropenic infections in patients predicted to be at low risk for complications.15 To date, trials comparing fluoroquinolones with intravenous antibiotics have required patients to be hospitalized until fever and neutropenia resolve,16,17 so routine use of this alternative approach is not yet appropriate for patients receiving chemotherapy.
In conclusion, the administration of levofloxacin for seven days to cover the expected period of severe neutropenia after cyclic, standard-dose, myelosuppressive chemotherapy in patients with solid cancers or lymphoma significantly reduced the incidence of clinically documented infection and hospitalization for the treatment of neutropenic infection, with minimal adverse effects. The small number of isolates identified and the incomplete susceptibility data did not allow us to determine the effect of prophylaxis on antibacterial resistance.
Our findings can be used to develop rational strategies to minimize the effect of infection during neutropenia in patients with cancer. Our results complement the positive findings of a contemporaneous Italian collaborative trial of levofloxacin prophylaxis reported elsewhere in this issue of the Journal.18 Taken together, the findings call for detailed microbiologic studies to determine whether the demonstrated clinical benefit is associated with resistance problems in the wider community of patients with cancer.
Hoechst Marion Roussel (now part of Sanofi Aventis) provided an educational grant and trial medication. Cancer Research UK provides a core grant to the Clinical Trials Unit, Birmingham.
Dr. Cullen reports having received research grant support from Eli Lilly and Sanofi Aventis and having received lecture fees from and having served on paid advisory boards for Sanofi Aventis, Eli Lilly, and AstraZeneca. Dr. Rea reports having received research grant support from Sanofi Aventis and having received lecture fees from Pfizer. Mr. Stanley reports having received lecture fees from Sanofi Aventis, Bristol-Myers Squibb, and AstraZeneca. Dr. Gollins reports having received research grant support from Sanofi Aventis and Roche.
We are indebted to Drs. Christopher Gallagher, Gordon Rustin, and Jim Slattery and Prof. Michael Whitehouse (data monitoring and ethics committee); to Susan Whitmarsh (pharmacy); and to Sarah Bathers, Rebecca Hindle, Helen Howard, Mary Ann Macham, Julia Mason, Caroline Price, and Steve Harris (trial coordination and information-technology support) for their help and support.
Source Information
From University Hospital Birmingham Cancer Centre, Birmingham (M.C., I.F.); Ysbyty Gwynedd, Bangor (N.S.); Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham (N.S., L.B., C.G., D.R.); the National Public Health Service Wales, Microbiology, Cardiff (M.H.); Royal South Hampshire Hospital, Southampton (P.S.); Glan Clwyd, Rhyl (S.G.); Chelsea and Westminster Hospital, London (M.B.); Royal Marsden Hospital, London (R.H.); and City Hospital, Birmingham (A.S.) — all in the United Kingdom.
Address reprint requests to Dr. Cullen at University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom, or at michael.cullen@uhb.nhs.uk.
The other members of the SIGNIFICANT Trial Group are listed in the Appendix.
Appendix
In addition to the authors, the following investigators participated in the SIGNIFICANT Trial: S. Al-Ismail (Singleton, Swansea), A. Al-Samarraie (Glan Clwyd, Rhyl), C. Alcock (Stoke Mandeville, Aylesbury), R. Allerton (New Cross, Wolverhampton), A. Anthony (Cookridge, Leeds), A. Axford (Bronglais General, Aberystwyth), N. Bailey (Derriford, Plymouth and Torbay), J. Barber (Velindre, Cardiff), D. Bareford (City Hospital, Birmingham), A. Barrett (Western Infirmary, Glasgow), P. Barrett-Lee (Velindre, Cardiff), N. Bates (Stoke Mandeville, Aylesbury), E. Bessell (Nottingham City), J. Bishop (Glan Clwyd, Rhyl, and Ysbyty Gwynedd, Bangor), A. Biswas (Royal Preston), P. Bliss (Royal Devon and Exeter and Torbay), S. Bolam (Taunton and Somerset), M. Bond (Cookridge, Leeds), C. Brammer (Kidderminster and New Cross, Wolverhampton), A. Brewster (Royal Gwent and Velindre), A. Brownell (Oldchurch, Romford), J. Carmichael (Nottingham City), P. Chakraborti (Derbyshire Royal Infirmary, Derby), A. Champion (Glan Clwyd, Rhyl), A. Chetiyawardana (Queen Elizabeth, Birmingham), M. Churn (Kidderminster and New Cross, Wolverhampton), P. Clark (Clatterbridge, Wirral), J. Clarke (Belvoir Park, Belfast), M. Collinson (Royal Cornwall, Truro), S. Crawford (Airedale, Keighley), D. Dearnley (Royal Marsden, London), D. Dodwell (Cookridge, Leeds), D. Dunlop (Western Infirmary, Glasgow), D. Edwards (Glan Clywd, Rhyl), S. Elyan (Cheltenham General, Cheltenham), D. Farrugia (Cheltenham General, Cheltenham), D. Fermont (Northwick Park, Harrow), D. Fyfe (Nottingham City), C. Gaffney (Royal Gwent, Newport and Velindre, Cardiff), J. Gardiner (North Tyneside General, North Shields), D. Gilligan (Hinchingbrooke, Huntingdon), A. Goodman (Royal Devon and Exeter and Torbay), D. Gozzard (Glan Clwyd, Rhyl), T. Gulliford (St. Mary's, Portsmouth), D. Guthrie (Derbyshire Royal Infirmary, Derby), B. Hancock (Weston Park, Sheffield), P. Harper (Guy's and St. Thomas', London), P. Harrison (Russell's Hall, Dudley), Y. Hassan (Sandwell General, West Bromwich), A. Hong (Royal Devon and Exeter and Torbay), A. Horwich (Royal Marsden, Sutton), S. Houston (Royal Surrey County, Guildford), T. Iveson (Royal South Hants, Southampton), P. Jenkins (Cheltenham General, Cheltenham), J. Joffe (Huddersfield Royal Infirmary, Huddersfield), P. Johnson (Royal South Hants, Southampton), S. Kaye (Western Infirmary, Glasgow), S. Kumar (Pinderfields General, Wakefield), S. Lewis (Singleton, Swansea), F. MacBeth (Llandough, Cardiff), P. Mack (Diana Princess of Wales, Grimsby), E. Marshall (Clatterbridge, Wirral), T. Maughan (Velindre Hospital, Cardiff), K. McAdam (Addenbrookes, Cambridge and Peterborough), J. McAleer (Belfast City Hospital, Belfast), G. Mead (Royal South Hants, Southampton), R. Mehra (New Cross, Wolverhampton), S. Morgan (Nottingham City), M. Muers (Leeds General Infirmary, Leeds), J. Murray (Queen Elizabeth, Birmingham), P. Murray (Essex County, Colchester), A. Neal (Essex County, Colchester), J. Neilson (Russell's Hall, Dudley), A. Nethersell (Glan Clwyd, Rhyl), M. O'Brien (Royal Marsden, Sutton and Kent Oncology Centre, Maidstone), A. O'Callaghan (St. Mary's, Portsmouth), S. O'Reilly (Clatterbridge, Wirral), C. Ottensmeier (Royal South Hants, Southampton), J. Owen (Cheltenham General, Cheltenham), D. Peake (City Hospital and Queen Elizabeth, Birmingham), I. Pedley (Newcastle General, Newcastle), C. Poole (City Hospital and Queen Elizabeth, Birmingham), D. Prangnell (Lincoln County), B. Pratt (Essex County, Colchester), M. Quigley (Oldchurch, Romford), A. Rathmell (James Cook, Middlesbrough), F. Roberts (Pontefract), S. Sadullah (James Paget, Great Yarmouth), A. Samanci (Glan Clywd, Rhyl), J. Seale (Ysbyty Gwynedd, Bangor), D. Sebag-Montefiore (Pinderfields, Wakefield), J. Shamash (Oldchurch, Romford), H. Smedley (Kent Oncology Centre, Canterbury), D. Smith (Clatterbridge, Wirral), I. Smith (Royal Marsden, London and Sutton), S. Smith (Torbay), M. Snee (Cookridge, Leeds), M. Sokal (Nottingham City), T. Sreenivasan (Scunthorpe General), P. Stableforth (Sandwell General, West Bromwich), N. Storey (James Cook University, Middlesbrough), C. Tiplady (North Tyneside General, North Shields), D. Turner (Torbay), S. Upadhyay (Diana Princess of Wales, Grimsby), P. Vasey (Western Infirmary, Glasgow), N. Wadd (James Cook University, Middlesbrough), D. Wheatley (Royal Cornwall, Truro), M. Williams (Addenbrookes, Cambridge and Hinchingbrook, Huntingdon), P. Woll (Nottingham City), J. Wright (City Hospital, Birmingham), H. Yosef (Hairmyres, East Kilbride).
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Full Text | Web of Science | Medline
- Citing Articles (96)
Citing Articles
1
Anat Gafter-Gvili, Abigail Fraser, Mical Paul, Liat Vidal, Theresa A Lawrie, Marianne D van de Wetering, Leontien CM Kremer, Leonard Leibovici, Anat Gafter-Gvili. 2012. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. .
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B. S. Sohn, D. H. Yoon, S. Kim, K. Lee, E. H. Kang, J. S. Park, D. H. Lee, S. H. Kim, J. Huh, C. Suh. (2011) The role of prophylactic antimicrobials during autologous stem cell transplantation: a single-center experience. European Journal of Clinical Microbiology & Infectious Diseases
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Vasileios Kouranos, George Dimopoulos, Antonios Vassias, Kostas N. Syrigos. (2011) Chemotherapy-induced neutropenia in lung cancer patients: The role of antibiotic prophylaxis. Cancer Letters 313:1, 9-14
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Stella J. Bowcock, Vincenzo Fontana, Hannah E. Patrick. (2011) Very poor performance status elderly patients with aggressive B cell lymphomas can benefit from intensive chemotherapy. British Journal of Haematologyno-no
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J. Janne Vehreschild, Gregor Moritz, Maria J.G.T. Vehreschild, Dorothee Arenz, Martina Mahne, Henning Bredenfeld, Jens Chemnitz, Florian Klein, Birgit Cremer, Boris Böll, Ingrid Kaul, Gernot Wassmer, Michael Hallek, Christof Scheid, Oliver A. Cornely. (2011) Efficacy and safety of moxifloxacin as antibacterial prophylaxis for patients receiving autologous haematopoietic stem cell transplantation: a randomised trial. International Journal of Antimicrobial Agents
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P. Jenkins, J. Scaife, S. Freeman. (2011) Validation of a predictive model that identifies patients at high risk of developing febrile neutropaenia following chemotherapy for breast cancer. Annals of Oncology
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Wolfgang Schuette, Sylke Nagel, Ludwig Fischer von Weikersthal, Stefan Pabst, Christian Schumann, Burkhard Deuss, Thorsten Salm, Katrin Roscher, Nicolas Dickgreber. (2011) Randomized Phase III Trial of Docetaxel Plus Carboplatin with or without Levofloxacin Prophylaxis in Elderly Patients with Advanced Non-small Cell Lung Cancer. Journal of Thoracic Oncology1
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C. Zwick, F. Hartmann, S. Zeynalova, V. Poschel, C. Nickenig, M. Reiser, E. Lengfelder, N. Peter, G. Schlimok, J. Schubert, N. Schmitz, M. Loeffler, M. Pfreundschuh, . (2011) Randomized comparison of pegfilgrastim day 4 versus day 2 for the prevention of chemotherapy-induced leukocytopenia. Annals of Oncology 22:8, 1872-1877
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Qing Ye, Xiaojun Xu, Yi Zheng, Xuejun Chen. (2011) Etiology of Septicemia in Children With Acute Leukemia. Journal of Pediatric Hematology/Oncology 33:5, e186-e191
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Maureen K. Bolon. (2011) The Newer Fluoroquinolones. Medical Clinics of North America 95:4, 793-817
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Emmanouil Saloustros, Kostas Tryfonidis, Vassilis Georgoulias. (2011) Prophylactic and therapeutic strategies in chemotherapy-induced neutropenia. Expert Opinion on Pharmacotherapy 12:6, 851-863
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Je-Hwan Lee, Kyoo-Hyung Lee, Jung-Hee Lee, Dae-Young Kim, Sung-Han Kim, Sung-Nam Lim, Sung-Doo Kim, Yunsuk Choi, Sang-Min Lee, Won-Sik Lee, Moon-Young Choi, Young-Don Joo. (2011) Decreased incidence of febrile episodes with antibiotic prophylaxis in the treatment of decitabine for myelodysplastic syndrome. Leukemia Research 35:4, 499-503
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A. G. Freifeld, E. J. Bow, K. A. Sepkowitz, M. J. Boeckh, J. I. Ito, C. A. Mullen, I. I. Raad, K. V. Rolston, J.-A. H. Young, J. R. Wingard. (2011) Executive Summary: Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 52:4, 427-431
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A. G. Freifeld, E. J. Bow, K. A. Sepkowitz, M. J. Boeckh, J. I. Ito, C. A. Mullen, I. I. Raad, K. V. Rolston, J.-A. H. Young, J. R. Wingard. (2011) Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 52:4, e56-e93
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Youssef A. Al-Tonbary, Othman E. Soliman, Mohammed M. Sarhan, Moustafa A. Hegazi, Rasha A. El-Ashry, Ashraf A. El-Sharkawy, Osama S. Salama, Raida Yahya. (2011) Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study. World Journal of Pediatrics 7:1, 60-64
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M Okera, S Chan, U Dernede, J Larkin, S Popat, D Gilbert, L Jones, N Osuji, H Sykes, C Oakley, L Pickering, F Lofts, S Chowdhury. (2011) A prospective study of chemotherapy-induced febrile neutropenia in the South West London Cancer Network. Interpretation of study results in light of NCAG/NCEPOD findings. British Journal of Cancer 104:3, 407-412
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Jean A. Klastersky, Marianne Paesmans. (2011) Treatment of Febrile Neutropenia Is Expensive: Prevention Is the Answer. Onkologie 34:5, 226-228
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Christian Winter, Peter Albers. (2011) Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nature Reviews Endocrinology 7:1, 43-53
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Dong-Gun Lee, Sung-Han Kim, Soo Young Kim, Chung-Jong Kim, Chang-Ki Min, Wan Beom Park, Yeon-Joon Park, Young Goo Song, Joung-Soon Jang, Jun Ho Jang, Jong Youl Jin, Jung-Hyun Choi. (2011) Evidence-based Guidelines for Empirical Therapy of Neutropenic Fever in Korea. Infection and Chemotherapy 43:4, 258
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M. A. Slavin, S. Lingaratnam, L. Mileshkin, D. L. Booth, M. J. Cain, D. S. Ritchie, A. Wei, K. A. Thursky. (2011) Use of antibacterial prophylaxis for patients with neutropenia. Internal Medicine Journal 41:1b, 102-109
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Bhanu Vakkalanka, Brian K. Link. (2011) Neutropenia and Neutropenic Complications in ABVD Chemotherapy for Hodgkin Lymphoma. Advances in Hematology 2011, 1-7
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Jean-Philippe Lanoix, Emilie Pluquet, Francois Lescure, Houcine Bentayeb, Emmanuelle Lecuyer, Marie Boutemy, Patrick Dumont, Vincent Jounieaux, Jean Schmit, Charles Dayen, Youcef Douadi. (2011) Bacterial infection profiles in lung cancer patients with febrile neutropenia. BMC Infectious Diseases 11:1, 183
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Dong-Gun Lee, Sung-Han Kim, Soo Young Kim, Chung-Jong Kim, Wan Beom Park, Young Goo Song, Jung-Hyun Choi. (2011) Evidence-Based Guidelines for Empirical Therapy of Neutropenic Fever in Korea. The Korean Journal of Internal Medicine 26:2, 220
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Sarah Alexander, Michael Nieder, Danielle M. Zerr, Brian T. Fisher, Christopher C. Dvorak, Lillian Sung. (2011) Prevention of bacterial infection in pediatric oncology: What do we know, what can we learn?. Pediatric Blood & Cancern/a-n/a
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E.M. Teoh, D.P. Dearnaley, A. Horwich, N. Van As, U. Riley, R.A. Huddart. (2010) The Efficacy of Preventing Neutropenic Sepsis in Patients with Testicular Germ Cell Tumours: Results of Two Consecutive Audits. Clinical Oncology 22:10, 891-892
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Jean-François Morère, Jeanne-Marie Bréchot, Virginie Westeel, Valerie Gounant, Bernard Lebeau, Fabien Vaylet, Fabrice Barlési, Thierry Urban, Pierre-Jean Souquet, Didier Debieuvre, Laurence Baudrin, Gérard Zalcman, Franck Morin, Bernard Milleron, Denis Moro-Sibilot. (2010) Randomized phase II trial of gefitinib or gemcitabine or docetaxel chemotherapy in patients with advanced non-small-cell lung cancer and a performance status of 2 or 3 (IFCT-0301 study). Lung Cancer 70:3, 301-307
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Evangelos Eleutherakis-Papaiakovou, Evangelos Kostis, Magda Migkou, Dimitrios Christoulas, Evangelos Terpos, Maria Gavriatopoulou, Maria Roussou, Evangelos Bournakis, Efstathios Kastritis, Eleni Efstathiou, Meletios A. Dimopoulos, Christos A. Papadimitriou. (2010) Prophylactic antibiotics for the prevention of neutropenic fever in patients undergoing autologous stem-cell transplantation: Results of a single institution, randomized phase 2 trial. American Journal of Hematology 85:11, 863-867
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Jaeheon Jeong, Byoung Chul Cho, Joo Hyuk Sohn, Hye Jin Choi, Se Hyun Kim, Young Joo Lee, Min Kyu Jung, Sang Joon Shin, Moo-Suk Park, Se Kyu Kim, Joon Chang, Joo Hang Kim. (2010) Belotecan for relapsing small-cell lung cancer patients initially treated with an irinotecan-containing chemotherapy: A phase II trial. Lung Cancer 70:1, 77-81
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, H. Syrjälä, P. Ohtonen, U. Kinnunen, R. Räty, E. Elonen, T. Nousiainen, E. Jantunen, K. Remes, M. Itälä-Remes, R. Silvennoinen, P. Koistinen. (2010) Blood stream infections during chemotherapy-induced neutropenia in adult patients with acute myeloid leukemia: treatment cycle matters. European Journal of Clinical Microbiology & Infectious Diseases 29:10, 1211-1218
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Francesco Menichetti. (2010) Infectious complications in neutropenic cancer patients. Internal and Emergency Medicine 5:S1, 21-25
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Coralia N. Mihu, Paul R. Rhomberg, Ronald N. Jones, Elizabeth Coyle, Randall A. Prince, Kenneth V. Rolston. (2010) Escherichia coli resistance to quinolones at a comprehensive cancer center. Diagnostic Microbiology and Infectious Disease 67:3, 266-269
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J. de Naurois, I. Novitzky-Basso, M. J. Gill, F. M. Marti, M. H. Cullen, F. Roila, . (2010) Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology 21:Supplement 5, v252-v256
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L. Jost, F. Roila, . (2010) Management of cancer pain: ESMO Clinical Practice Guidelines. Annals of Oncology 21:Supplement 5, v257-v260
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K A Guthrie, M Yong, D Frieze, L Corey, D N Fredricks. (2010) The impact of a change in antibacterial prophylaxis from ceftazidime to levofloxacin in allogeneic hematopoietic cell transplantation. Bone Marrow Transplantation 45:4, 675-681
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N. Zojer, H. Ludwig. (2010) Supportive Therapie bei multiplem Myelom. Der Onkologe 16:3, 298-308
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Pol Specenier, Marika Rasschaert, Jan Van den Brande, Joke Dyck, Dirk Schrijvers, Manon T. Huizing, Jan B. Vermorken. (2010) Docetaxel, ifosfamide and cisplatin in solid tumour treatment: a phase I study. Anti-Cancer Drugs 21:3, 306-312
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Gopi Rangaraj, Bruno P. Granwehr, Ying Jiang, Ray Hachem, Issam Raad. (2010) Perils of quinolone exposure in cancer patients. Cancer 116:4, 967-973
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Maureen K. Bolon. (2009) The Newer Fluoroquinolones. Infectious Disease Clinics of North America 23:4, 1027-1051
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John R. Wingard, Mohamed Elmongy. (2009) Strategies for minimizing complications of neutropenia: Prophylactic myeloid growth factors or antibiotics. Critical Reviews in Oncology/Hematology 72:2, 144-154
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M. Bommer, M. Kull. (2009) Supportivtherapie bei Urogenitaltumoren. Der Urologe 48:11, 1273-1282
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Lennert Slobbe, Loes van der Waal, Lydia R. Jongman, Pieternella J. Lugtenburg, Bart J.A. Rijnders. (2009) Three-day treatment with imipenem for unexplained fever during prolonged neutropaenia in haematology patients receiving fluoroquinolone and fluconazole prophylaxis: A prospective observational safety study. European Journal of Cancer 45:16, 2810-2817
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Karen J. Vigil, Javier A. Adachi, Halim Aboufaycal, Ray Y. Hachem, Ruth A. Reitzel, Ying Jiang, Jeffrey J. Tarrand, Roy F. Chemaly, Gerald P. Bodey, Kenneth V. Rolston, Isaam Raad. (2009) Multidrug-resistant Escherichia coli bacteremia in cancer patients. American Journal of Infection Control 37:9, 741-745
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C. Zwick, N. Murawski, Michael Pfreundschuh. (2009) Treatment of diffuse large B-cell lymphomas. memo - Magazine of European Medical Oncology 2:3, 150-153
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M Cullen, S Baijal. (2009) Prevention of febrile neutropenia: use of prophylactic antibiotics. British Journal of Cancer 101, S11-S14
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Catherine D. Cooksley, Elenir B. C. Avritscher, Kenneth V. Rolston, Linda S. Elting. (2009) Hospitalizations for infection in cancer patients: impact of an aging population. Supportive Care in Cancer 17:5, 547-554
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Han Sung Choi, Kyung Hee Jung, Seung Chul Lee, Sung Vin Yim, Joo-Ho Chung, Youn Wha Kim, Woo Kyu Jeon, Hoon Pyo Hong, Young Gwan Ko, Chul-Ho Kim, Ki-Hyo Jang, Soon Ah Kang. (2009) Bovine Colostrum Prevents Bacterial Translocation in an Intestinal Ischemia/Reperfusion-Injured Rat Model. Journal of Medicinal Food 12:1, 37-46
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Christine Herbst, Frauke Naumann, Eva-Brigitta Kruse, Ina Monsef, Julia Bohlius, Holger Schulz, Andreas Engert, Christine Herbst. 2009. Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. .
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Jennifer Pascoe, Neil Steven. (2009) Antibiotics for the prevention of febrile neutropenia. Current Opinion in Hematology 16:1, 48-52
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Yuko Kanbayashi, Kenichi Nomura, Yoshiko Fujimoto, Mihoko Yamashita, Muneo Ohshiro, Kousuke Okamoto, Yosuke Matsumoto, Shigeo Horiike, Tatsuya Takagi, Yoji Ishida, Masafumi Taniwaki, . (2009) Risk factors for infection in haematology patients treated with rituximab. European Journal of Haematology 82:1, 26-30
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Jeong-Ok Lee, Dae-Young Kim, Joo Han Lim, Myung-Deock Seo, Hyeon Gyu Yi, Yu Jung Kim, Se-Hoon Lee, Dong-Wan Kim, Seok-Chul Yang, Young Whan Kim, Dae Seog Heo. (2008) Risk factors for bacterial pneumonia after cytotoxic chemotherapy in advanced lung cancer patients. Lung Cancer 62:3, 381-384
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Olivier Lortholary, Agnès Lefort, Michel Tod, Anne-Marie Chomat, Clémence Darras-Joly, Catherine Cordonnier. (2008) Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropenia. The Lancet Infectious Diseases 8:10, 612-620
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Michael Ellis. (2008) Febrile Neutropenia. Annals of the New York Academy of Sciences 1138:1, 329-350
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Andreas Meisel, Christian Meisel. (2008) Stroke-induced immunodepression: consequences, mechanisms and therapeutic implications. Future Neurology 3:5, 551-563
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Beth Kurt, Patricia Flynn, Jerry L. Shenep, Stanley Pounds, Shelly Lensing, Raul C. Ribeiro, Ching‐Hon Pui, Bassem I. Razzouk, Jeffrey E. Rubnitz. (2008) Prophylactic antibiotics reduce morbidity due to septicemia during intensive treatment for pediatric acute myeloid leukemia. Cancer 113:2, 376-382
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Ashwin Jathavedam, Darren R. Feldman, Nicole Ishill, Stefan Turkula, Sujata Patil, George J. Bosl, Robert J. Motzer, David M. Weinstock. (2008) Infectious Complications from High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Metastatic Germ Cell Tumors. Biology of Blood and Marrow Transplantation 14:5, 595-600
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C Herbst, F Naumann, E Kruse, I Knauel, H Schulz, J Bohlius, A Engert, Christine Herbst. 2008. Prophylactic antibiotics and G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. .
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Kenneth V. I. Rolston, Gerald Bodey. 2008. Bacterial Infections in Cancer Patients. , 1-25.
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Jeffrey Crawford. 2008. Myeloid Growth Factors. , 1-29.
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Adi Eldar-Lissai, Leon E. Cosler, Eva Culakova, Gary H. Lyman. (2008) Economic Analysis of Prophylactic Pegfilgrastim in Adult Cancer Patients Receiving Chemotherapy. Value in Health 11:2, 172-179
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Georg Maschmeyer, Antje Haas. (2008) The epidemiology and treatment of infections in cancer patients. International Journal of Antimicrobial Agents 31:3, 193-197
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T. Saito, S. Yoshioka, Y. Iinuma, S. Takakura, N. Fujihara, T. Ichinohe, T. Ishikawa, T. Uchiyama, S. Ichiyama. (2008) Effects on spectrum and susceptibility patterns of isolates causing bloodstream infection by restriction of fluoroquinolone prophylaxis in a hematology–oncology unit. European Journal of Clinical Microbiology & Infectious Diseases 27:3, 209-216
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Susanne Krege, Jörg Beyer, Rainer Souchon, Peter Albers, Walter Albrecht, Ferran Algaba, Michael Bamberg, István Bodrogi, Carsten Bokemeyer, Eva Cavallin-Ståhl, Johannes Classen, Christoph Clemm, Gabriella Cohn-Cedermark, Stéphane Culine, Gedske Daugaard, Pieter H.M. De Mulder, Maria De Santis, Maike de Wit, Ronald de Wit, Hans Günter Derigs, Klaus-Peter Dieckmann, Annette Dieing, Jean-Pierre Droz, Martin Fenner, Karim Fizazi, Aude Flechon, Sophie D. Fosså, Xavier Garcia del Muro, Thomas Gauler, Lajos Geczi, Arthur Gerl, Jose Ramon Germa-Lluch, Silke Gillessen, Jörg T. Hartmann, Michael Hartmann, Axel Heidenreich, Wolfgang Hoeltl, Alan Horwich, Robert Huddart, Michael Jewett, Johnathan Joffe, William G. Jones, László Kisbenedek, Olbjørn Klepp, Sabine Kliesch, Kai Uwe Koehrmann, Christian Kollmannsberger, Markus Kuczyk, Pilar Laguna, Oscar Leiva Galvis, Volker Loy, Malcolm D. Mason, Graham M. Mead, Rolf Mueller, Craig Nichols, Nicola Nicolai, Tim Oliver, Dalibor Ondrus, Gosse O.N. Oosterhof, Luis Paz-Ares, Giorgio Pizzocaro, Jörg Pont, Tobias Pottek, Tom Powles, Oliver Rick, Giovanni Rosti, Roberto Salvioni, Jutta Scheiderbauer, Hans-Ulrich Schmelz, Heinz Schmidberger, Hans-Joachim Schmoll, Mark Schrader, Felix Sedlmayer, Niels E. Skakkebaek, Aslam Sohaib, Sergei Tjulandin, Padraig Warde, Stefan Weinknecht, Lothar Weissbach, Christian Wittekind, Eva Winter, Lori Wood, Hans von der Maase. (2008) European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. European Urology 53:3, 497-513
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Alison Freifeld, Jayashri Sankaranarayanan, Fred Ullrich, Junfeng Sun. (2008) Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA. Supportive Care in Cancer 16:2, 181-191
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Sarah P. Hammond, Lindsey R. Baden. (2008) Antibiotic prophylaxis for patients with acute leukemia. Leukemia & Lymphoma 49:2, 183-193
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M Debled, N Houédé, N Madranges, C Donamaria, A Floquet, M Durand, Louis Mauriac. (2007) Does chemotherapy-induced neutropaenia result in a postponement of adjuvant or neoadjuvant regimens in breast cancer patients? Results of a retrospective analysis. British Journal of Cancer 97:12, 1642-1647
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Anastasia Antoniadou, Helen Giamarellou. (2007) Fever of Unknown Origin in Febrile Leukopenia. Infectious Disease Clinics of North America 21:4, 1055-1090
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H. Imran, I. M. Tleyjeh, C. A. S. Arndt, L. M. Baddour, P. J. Erwin, C. Tsigrelis, N. Kabbara, V. M. Montori. (2007) Fluoroquinolone prophylaxis in patients with neutropenia: a meta-analysis of randomized placebo-controlled trials. European Journal of Clinical Microbiology & Infectious Diseases 27:1, 53-63
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E. Castagnola, V. Fontana, I. Caviglia, S. Caruso, M. Faraci, F. Fioredda, M. L. Garre, C. Moroni, M. Conte, G. Losurdo, F. Scuderi, R. Bandettini, P. Toma, C. Viscoli, R. Haupt. (2007) A Prospective Study on the Epidemiology of Febrile Episodes during Chemotherapy-Induced Neutropenia in Children with Cancer or after Hemopoietic Stem Cell Transplantation. Clinical Infectious Diseases 45:10, 1296-1304
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Claudio Viscoli. (2007) Antibacterial prophylaxis in neutropenic patients. International Journal of Antimicrobial Agents 30, 60-65
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M. Paul, A. Gafter-Gvili, A. Fraser, L. Leibovici. (2007) The anti-cancer effects of quinolone antibiotics?. European Journal of Clinical Microbiology & Infectious Diseases 26:11, 825-831
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Guy Pratt, Oliver Goodyear, Paul Moss. (2007) Immunodeficiency and immunotherapy in multiple myeloma. British Journal of Haematology 138:5, 563-579
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Giampaolo Bucaneve, Elio Castagnola, Claudio Viscoli, Leonard Leibovici, Francesco Menichetti. (2007) Quinolone prophylaxis for bacterial infections in afebrile high risk neutropenic patients. European Journal of Cancer Supplements 5:2, 5-12
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Christina Hart, Christian Blank, Stefan W. Krause, Reinhard Andreesen, Burkhard Hennemann. (2007) Ifosfamide, epirubicin, and etoposide (IEV) mobilize peripheral blood stem cells more efficiently than cyclophosphamide/etoposide. Annals of Hematology 86:8, 575-581
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Sarah P. Hammond, Lindsey R. Baden. (2007) Antibiotic prophylaxis during chemotherapy-induced neutropenia for patients with acute leukemia. Current Hematologic Malignancy Reports 2:2, 97-103
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G. J. Timmers, A. M. Simoons-Smit, M. E. Leidekker, J. J. W. M. Janssen, C. M. J. E. Vandenbroucke-Grauls, P. C. Huijgens. (2007) Levofloxacin vs. ciprofloxacin plus phenethicillin for the prevention of bacterial infections in patients with haematological malignancies. Clinical Microbiology and Infection 13:5, 497-503
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Nicolas Mounier, Michele Spina, Christian Gisselbrecht. (2007) Modern management of non-Hodgkin lymphoma in HIV-infected patients. British Journal of Haematology 136:5, 685-698
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P. Stiefelhagen. (2007) Internisten-Update 2006. Der Internist 48:2, 213-216
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J.A. Stockman. (2007) Antibacterial Prophylaxis After Chemotherapy for Solid Tumors and Lymphomas. Yearbook of Pediatrics 2007, 461-464
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J.D. Chretin, K.M. Rassnick, N.A. Shaw, K.A. Hahn, G.K. Ogilvie, O. Kristal, N.C. Northrup, A.S. Moore. (2007) Prophylactic Trimethoprim-Sulfadiazine during Chemotherapy in Dogs with Lymphoma and Osteosarcoma: A Double-Blind, Placebo-Controlled Study. Journal of Veterinary Internal Medicine 21:1, 141-148
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Barbara F. Eichhorst, Raymonde Busch, Carmen Schweighofer, Clemens M. Wendtner, Berthold Emmerich, Michael Hallek, . (2007) Due to low infection rates no routine anti-infective prophylaxis is required in younger patients with chronic lymphocytic leukaemia during fludarabine-based first line therapy. British Journal of Haematology 136:1, 63-72
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Udai Banerji, Sue Ashley, Jim Coward, Sarah Hughes, Ying Zee, Taqdir Benepal, Alison Norton, Tim Eisen, Mary O’Brien. (2006) The association of chemotherapy induced neutropenia on treatment outcomes in small cell lung cancer. Lung Cancer 54:3, 371-377
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Leonard Leibovici, Mical Paul, Michael Cullen, Giampaolo Bucaneve, Anat Gafter-Gvili, Abigail Fraser, Winfried V. Kern. (2006) Antibiotic prophylaxis in neutropenic patients. Cancer 107:8, 1743-1751
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Alison Freifeld, Kent Sepkowitz. (2006) The conundrum of fluoroquinolone prophylaxis. Nature Clinical Practice Oncology 3:10, 524-525
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Nangi Lo, Michael Cullen. (2006) Antibiotic prophylaxis in chemotherapy-induced neutropenia: time to reconsider. Hematological Oncology 24:3, 120-125
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Johanna N.H. Timmer-Bonte, Vivianne C.G. Tjan-Heijnen. (2006) Febrile neutropenia: highlighting the role of prophylactic antibiotics and granulocyte colony-stimulating factor during standard dose chemotherapy for solid tumors. Anti-Cancer Drugs 17:8, 881-889
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Jennifer Pascoe, Michael Cullen. (2006) The prevention of febrile neutropenia. Current Opinion in Oncology 18:4, 325-329
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Walter T Hughes. (2006) Should prophylactic antibiotics be used in afebrile neutropenic oncology patients?. Nature Clinical Practice Oncology 3:3, 130-131
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(2006) Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiology and Drug Safety 15:3, i-xii
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(2006) Antibacterial Prophylaxis in Patients with Cancer and Neutropenia. New England Journal of Medicine 354:1, 90-94
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Dong Hoe Koo, Ock Bae Ko, Shin Kim, Dae Ho Lee, Sang We Kim, Cheolwon Suh. (2006) Prospective Randomized Comparative Observations of Infectious Complications with or without Antimicrobial Prophylaxis, during Autologous Stem Cell Transplantation. The Korean Journal of Hematology 41:4, 282
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H Innes, L Billingham, C Gaunt, N Steven, E Marshall. (2005) Management of febrile neutropenia in the United Kingdom: time for a national trial?. British Journal of Cancer 93:12, 1324-1328
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Enric Carreras, Josep Mensa. (2005) Neutropenia febril: pasado, presente y futuro. Enfermedades Infecciosas y Microbiología Clínica 23, 2-6
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Joaquín Díaz-Mediavilla, Manuel Lizasoain. (2005) Epidemiología de las infecciones en el paciente neutropénico. Enfermedades Infecciosas y Microbiología Clínica 23, 7-13
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Anat Gafter-Gvili, Abigail Fraser, Mical Paul, Marianne D van de Wetering, Leontien CM Kremer, Leonard Leibovici, Anat Gafter-Gvili. 2005. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. .
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Baden, Lindsey R., . (2005) Prophylactic Antimicrobial Agents and the Importance of Fitness. New England Journal of Medicine 353:10, 1052-1054
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A. Vermes. (2005) Profylactische antibioticabehandeling bij kankerpatiënten. Medisch-Farmaceutische Mededelingen 43:7, 235-236
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