Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Intern Med J. 2011 Jan;41(1b):102-9. doi: 10.1111/j.1445-5994.2010.02341.x.
The use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. Recent evidence has demonstrated non-significant but consistent, improvement in all-cause mortality when fluoroquinolones (FQs) are used as primary prophylaxis. However, the consensus was that this evidence was not strong enough to recommend prophylaxis. The evidence base for FQ prophylaxis is presented alongside current consensus opinion to guide the appropriate and judicious use of these agents. Due consideration is given to patient risk, as it pertains to specific patient populations, as well as the net effect on selective pressure from antibiotics if FQ prophylaxis is routinely used in a target population. The potential costs and consequences of emerging FQ resistance, particularly among Escherichia coli, Clostridium difficile and Gram-positive organisms, are considered. As FQ prophylaxis has been advocated in some chemotherapy protocols, specific regard is given to whether FQ prophylaxis should be used to support these regimens. The group also provides recommendations for monitoring and surveillance of emerging resistance in those centres that have adopted FQ prophylaxis.
由于缺乏证据表明降低死亡率，并且担心这种做法会促进抗生素耐药性，因此，中性粒细胞减少症患者使用口服预防性抗生素存在争议，本专家组不推荐使用。最近的证据表明，氟喹诺酮类药物（FQs）作为主要预防药物使用时，全因死亡率有非显著但一致的改善。然而，专家组认为，这一证据还不够强，不足以推荐预防。本文介绍了 FQ 预防的证据基础以及当前的共识意见，以指导这些药物的合理使用。由于考虑到了特定患者群体中与患者风险相关的因素，以及如果在目标人群中常规使用 FQ 预防，抗生素的选择压力的净效应，因此对 FQ 预防的合理性进行了充分考虑。还考虑了新兴 FQ 耐药性（尤其是大肠杆菌、艰难梭菌和革兰阳性菌）的潜在成本和后果。由于某些化疗方案中提倡使用 FQ 预防，因此特别关注 FQ 预防是否应用于支持这些方案。专家组还为采用 FQ 预防的中心提供了有关监测和检测新出现耐药性的建议。
