Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos / Critically appraised article: Levofloxacin to Prevent Bacterial Infection in Patients with Cancer and Neutropenia
Rev. méd. Chile
; 134(11): 1476-1479, nov. 2006. tab
Artigo
em Espanhol
| LILACS
| ID: lil-439942
Biblioteca responsável:
BR1.1
ABSTRACT
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.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
Outras Doenças Sanguíneas
Base de dados:
LILACS
Assunto principal:
Infecções Bacterianas
/
Antibioticoprofilaxia
/
Medicina Baseada em Evidências
/
Antibacterianos
/
Neoplasias
/
Neutropenia
Tipo de estudo:
Ensaio clínico controlado
/
Estudo de etiologia
Limite:
Humanos
Idioma:
Espanhol
Revista:
Rev. méd. Chile
Assunto da revista:
Medicina
Ano de publicação:
2006
Tipo de documento:
Artigo
País de afiliação:
Chile
Instituição/País de afiliação:
Pontificia Universidad Católica de Chile/CL