Levofloxacin to Prevent Bacterial Infection in Patients with Cancer and Neutropenia

In 760 patients with cancer in whom chemotherapy-induced neutropenia was expected to last more than seven days, those assigned to levofloxacin (500 mg daily) had a lower incidence of fever (65 percent vs. 85 percent) and clinically documented bacteremias than those assigned to placebo. The benefits of prophylaxis were similar in patients with acute leukemia and those with solid tumors or lymphoma. These data support the prophylactic use of levofloxacin in this high-risk population. Patients who were assigned to levofloxacin had a lower incidence of fever and clinically documented bacteremias than those assigned to placebo. These data support the prophylactic use of levofloxacin in this high-risk population. Bacterial infections are a major cause of complications and death in patients with hematologic cancers and chemotherapy-induced neutropenia. A number of randomized clinical trials and two meta-analyses 1 , 2 have suggested that prophylaxis with fluoroquinolones may be better than placebo or trimethoprim–sulfamethoxazole in reducing bacteremic infections caused by gram-negative bacilli, with ciprofloxacin being the compound most widely used. 3 However, the evidence provided by these studies is not seen as entirely convincing. First, only three studies were placebo-controlled, double-blind, randomized clinical trials, and none were sufficiently large to provide conclusive evidence of the real efficacy of prophylaxis. 4 – 6 Second, in most studies, . . .