Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos

Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos

Background: The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. Methods: We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic milli...

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Autores principales: Candia B,Roberto, Rada G,Gabriel
Lenguaje:Spanish / Castilian
Publicado: Sociedad Médica de Santiago 2006
Acceso en línea:http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100017
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spelling oai:scielo:S0034-988720060011000172014-01-24Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicosCandia B,RobertoRada G,GabrielBackground: The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. Methods: We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic millimeter) was expected to occur for more than seven days to receive either oral levofloxacin (500 mg daily) or placebo from the start of chemotherapy until the resolution of neutropenia. Patients were stratified according to their underlying disease (acute leukemia vs solid tumor or lymphoma). Results: An intention-to-treat analysis showed that fever was present for the duration of neutropenia in 65 percent of patients who received levofloxacin prophylaxis, as compared with 85 percent of those receiving placebo (243 of 375 vs 308 of 363; relative risk, 0.76; absolute difference in risk, -20 percent; 95 percent confidence interval, -26 to -14 percent; P=0.001). The levofloxacin group had a lower rate of microbiologically documented infections (absolute difference in risk, -17 percent; 95 percent confidence interval, -24 to -10 percent; P <0.001), bacteremias (difference in risk, -16 percent; 95 percent confidence interval, -22 to -9 percent; P <0.001), and single-agent gram-negative bacteremias (difference in risk, -7 percent; 95 percent confidence interval, -10 to -2 percent; P <0.01) than did the placebo group. Mortality and tolerability were similar in the two groups. The effects of prophylaxis were also similar between patients with acute leukemia and those with solid tumors or lymphoma. Conclusions: Prophylactic treatment with levofloxacin is an effective and well-tolerated way of preventing febrile episodes and other relevant infection-related outcomes in patients with cancer and profound and protracted neutropenia. The long-term effect of this intervention on microbial resistance in the community is not knowninfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.134 n.11 20062006-11-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100017es10.4067/S0034-98872006001100017
institution Scielo Chile
collection Scielo Chile
language Spanish / Castilian
description Background: The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. Methods: We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic millimeter) was expected to occur for more than seven days to receive either oral levofloxacin (500 mg daily) or placebo from the start of chemotherapy until the resolution of neutropenia. Patients were stratified according to their underlying disease (acute leukemia vs solid tumor or lymphoma). Results: An intention-to-treat analysis showed that fever was present for the duration of neutropenia in 65 percent of patients who received levofloxacin prophylaxis, as compared with 85 percent of those receiving placebo (243 of 375 vs 308 of 363; relative risk, 0.76; absolute difference in risk, -20 percent; 95 percent confidence interval, -26 to -14 percent; P=0.001). The levofloxacin group had a lower rate of microbiologically documented infections (absolute difference in risk, -17 percent; 95 percent confidence interval, -24 to -10 percent; P <0.001), bacteremias (difference in risk, -16 percent; 95 percent confidence interval, -22 to -9 percent; P <0.001), and single-agent gram-negative bacteremias (difference in risk, -7 percent; 95 percent confidence interval, -10 to -2 percent; P <0.01) than did the placebo group. Mortality and tolerability were similar in the two groups. The effects of prophylaxis were also similar between patients with acute leukemia and those with solid tumors or lymphoma. Conclusions: Prophylactic treatment with levofloxacin is an effective and well-tolerated way of preventing febrile episodes and other relevant infection-related outcomes in patients with cancer and profound and protracted neutropenia. The long-term effect of this intervention on microbial resistance in the community is not known
author Candia B,Roberto
Rada G,Gabriel
spellingShingle Candia B,Roberto
Rada G,Gabriel
Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
author_facet Candia B,Roberto
Rada G,Gabriel
author_sort Candia B,Roberto
title Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
title_short Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
title_full Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
title_fullStr Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
title_full_unstemmed Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos
title_sort análisis crítico de un artículo: levofloxacino profiláctico en pacientes neutropénicos
publisher Sociedad Médica de Santiago
publishDate 2006
url http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100017
work_keys_str_mv AT candiabroberto analisiscriticodeunarticulolevofloxacinoprofilacticoenpacientesneutropenicos
AT radaggabriel analisiscriticodeunarticulolevofloxacinoprofilacticoenpacientesneutropenicos
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