Evidence map›Paper›PMID 17938978›Full record

SynthesisEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2008

Fluoroquinolone prophylaxis in patients with neutropenia: a meta-analysis of randomized placebo-controlled trials.

H Imran, I M Tleyjeh, C A S Arndt, L M Baddour, P J Erwin, C Tsigrelis, N Kabbara, V M Montori

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 6 pooled it
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 6 syntheses or guidelines pooled it, 67 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Guideline
  6. Pooled it
  7. Article
  8. Article
  9. Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2018
    Article
  10. Article
  11. Moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2017
    Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Review
  17. Article
  18. New frontiers in pediatric Allo-SCT.Bone marrow transplantation · 2014
    Review
  19. Article
  20. Risk factors for, and clinical relevance of, faecal extended-spectrum β-lactamase producing Escherichia coli (ESBL-EC) carriage in neutropenic patients with haematological malignancies.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2011
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 3 countries.

H ImranDivision of Pediatric Hematology/Oncology, University of South Alabama, 1504 Springhill Avenue, Mobile, AL 36695, USA. imran@usouthal.edu
I M Tleyjeh
C A S Arndt
L M Baddour
P J Erwin
C Tsigrelis
N Kabbara
V M Montori
Mayo Clinic · USHôpital Saint-Louis · FRKing Fahd Medical City · SAMayo Clinic in Arizona · USUniversity of South Alabama · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

A recent meta-analysis, which included non-placebo open-labeled trials, showed that fluoroquinolone prophylaxis reduces mortality in neutropenic patients, whereas two recent large trials failed to show a similar benefit. Therefore, we performed a meta-analysis of randomized, blinded, placebo-controlled trials of fluoroquinolone prophylaxis in neutropenic patients. We searched several databases for relevant trials in any language. We used random effects models for pooling dichotomous data and assessed the between-study inconsistency with I (2). Two investigators independently assessed the eligibility and quality of the included trials. A total of 2,721 patients were randomized in eight eligible trials. Compared to the placebo, there was a statistically non-significant but consistent decrease in mortality with fluoroquinolone prophylaxis (4.5% vs. 3.9%, relative risk (RR) 0.76, 95% confidence interval (CI) 0.54, 1.08, p = 0.13, I (2) = 0%). Significant inconsistency, however, accompanied the pooled analysis of febrile episode (39% vs. 31%, RR 0.76, 95% CI 0.55, 1.03, p = 0.08, I (2) = 96.5%). To an extent, this inconsistency was explained in the subgroup analyses by the type of patient population studied and the type of fluoroquinolone used (p for interaction </=0.01 for both). The RR of febrile episodes for two trials of outpatients with solid tumors, including lymphomas, was RR 0.34 (95% CI 0.14, 0.80) and 0.60 (95% CI 0.33, 1.10) for two trials using levofloxacin prophylaxis. The RR in one of the two trials that used levofloxacin significantly favored the intervention, 0.76 (95% CI 0.70, 0.83). Fluoroquinolone prophylaxis reduces the risk of febrile episodes in neutropenic outpatients with solid tumors, including lymphomas, and is associated with a statistically non-significant, yet clinically important, decrease in mortality in all neutropenic patients. Prophylaxis with levofloxacin may reduce febrile episodes in neutropenic hematology patients and stem cell transplant recipients.

Indexed as

AdolescentAdultAgedAged, 80 and overAntibiotic ProphylaxisFluoroquinolonesHumansMiddle AgedNeoplasmsNeutropeniaOpportunistic InfectionsPlacebosRandomized Controlled Trials as TopicTreatment OutcomeFluoroquinolonesPlacebos

Identifiers

PMID17938978
OpenAlexW2020343919

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.