Abstract
Introduction: Chemotheapy-induced neutropenia can potentially cause fatal infections in cancer patients. Human granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are recommended as prophylaxis. Alternatively, prophylactic antibiotics have been administered.
Methods: A literature search in PubMed and Scopus was performed to identify randomized control trials and cohort clinical studies that evaluated the role of antibiotic prophylaxis in chemotherapy-induced neutropenia in lung cancer (LC) patients.
Results: Five randomized controlled trials, 2 non-randomized cohort studies, 1 comparative non-randomized case control study and 1 case report were identified as eligible for inclusion. A total of 1175 LC patients were evaluated to receive antibiotic prophylaxis during the expected neutropenic period or from the beginning until the completion of chemotherapy. The main histologic diagnosis was small cell LC in 720/1175 (61.7%) patients. Quinolones and trimethoprime/sulfomethoxazole were the main antibiotics used, while G-SCF were administered in totally 260/1175 (22.1%) patients. Studies showed that prophylactic use of antibiotics in LC patients undergoing chemotherapy reduced significantly the number of episodes of febrile neutropenia, documented infections and the duration of hospitalizations due to suspected infections.
Conclusion: Although antibiotic prophylaxis remains controversial due to the lack of survival advantage, and risk for antibiotic resistance, this systematic review showed that the prophylactic use of wide spectrum antibiotics in chemotherapy-induced neutropenia in LC patients could be considered as alternative therapeutic strategy.
- © 2011 ERS
