The use of quinolones as therapy in granulocytopenic cancer patients. Comparison with other antimicrobials.

Quinolones are valuable antimicrobial agents for prevention and therapy of febrile neutropenia. However, as with other groups of antibacterials, there are limitations to the use of quinolones in immunocompromised hosts: they should not be used in those neutropenic patients receiving ciprofloxacin or ofloxacin for prophylaxis, because of the risk of infection with resistant Gram-negative, or less susceptible Gram-positive, organisms. There are also insufficient data to support monotherapy of febrile neutropenia with quinolones, although some studies using higher ciprofloxacin dosages have reported encouraging results. More data on this issue, including use in paediatric cancer patients, are required. Quinolones are indicated for empirical therapy in combination with agents active against Gram-positive organisms, such as broad spectrum penicillins with or without beta-lactamase inhibitors, or in combination with vancomycin or teicoplanin. Some studies have shown that a combination of cefotaxime or ceftriaxone may provide better coverage against streptococci, but there are insufficient data on the combination of quinolones with third generation cephalosporins. A specific group of patients with low risk mild to moderate neutropenia with solid tumours may benefit from oral therapy with quinolones in combination with either an aminopenicillin with a beta-lactamase inhibitor or clindamycin. After 10 years of quinolone use in febrile neutropenia, these agents can still be regarded as valuable drugs of choice; however, the incidence of resistance among staphylococci and Pseudomonas spp., especially in centres using quinolones as prophylaxis, is increasing.