Fluoroquinolones exhibited short-term safety in low-risk patients with fever and neutropenia

Sung L. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e318245ab48.

The use of fluoroquinolones demonstrated positive outcomes and short-term safety in low-risk pediatric patients with fever and neutropenia, according to a study published online ahead of print.

To determine the effectiveness and safety of fluoroquinolones therapy in pediatric fever and neutropenia, researchers conducted electronic searches of eligible studies in which any fluoroquinolone was administered for fever and neutropenia. Researchers retrieved 380 full articles from 7,281 reviewed titles and abstracts; yet, only 66 of the 380 met the inclusion requirements dictating that: 1) the study examined any infection outcome of a homogenous initial empiric regimen; 2) the population focused on the pediatric demographic; and 3) the study was conducted prospectively as to avoid bias related to retrospective studies.

Of the 66 studies, 10 included a fluoroquinolone and were included in the meta-analysis, encompassing 740 episodes of fever and neutropenia. Five of the studies consisted of ciprofloxacin monotherapy, two studies consisted of other fluoroquinolone monotherapy (ofloxacin and gatifloxacin) and three studies consisted of combination fluoroquinolones. Six of the studies were randomized controlled trials and four were prospective non-randomized studies, with all studies consisting of low-risk fever and neutropenia episodes.

According to researchers, the risk of treatment failure was 17% among those given ciprofloxacin monotherapy, 17% among those given non-ciprofloxacin fluoroquinolone monotherapy and 24% among those given fluoroquinolone combination therapy (P=.80). Researchers also compared fluoroquinolone vs. non-fluoroquinolone antibiotics among the six randomized trials; they found no difference in treatment failure when antibiotic modification was included as a criterion for failure (RR=1.02; 95% CI, 0.72-1.45) or excluded as a criterion for failure (RR=1.70; 95% CI, 0.72-4.42).

Limitations of the analysis included a lack of address on the use of fluoroquinolones as prophylaxis, modification of empiric fever and neutropenia therapy or definitive treatment of infection in children with cancer, as well as a review of only short-term toxicities, excluding long-term toxicities such as arthritis, according to the study published in The Pediatric Infectious Disease Journal.

Disclosure: The researchers report no relevant financial disclosures

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