Prophylactic Antibiotics Beneficial After Chemotherapy

Protective isolation that includes antibiotics significantly reduces all-cause mortality

MONDAY, Dec. 22 (HealthDay News) -- After patients undergo chemotherapy, infection-control interventions that include prophylactic antibiotics are the most effective treatment within a protective environment, according to research published online Dec. 17 in The Lancet Infectious Diseases.

Agata Schlesinger, M.D., of Rabin Medical Center in Petah-Tikva, Israel, and colleagues conducted a systematic review and meta-analysis of 29 prospective studies comparing the effects of protective isolation, including air quality control, prophylactic antibiotics and barrier isolation. They also analyzed 11 non-randomized prospective studies that assessed inpatient versus outpatient management after autologous stem-cell transplantation.

In the first 29 studies, the researchers found that protective isolation was associated with significant reductions in all-cause mortality (risk ratio, 0.60) and that the inclusion of prophylactic antibiotics was necessary to demonstrate this effect. They found that the combined intervention reduced bacteremia, Gram-negative, Gram-positive and Candida spp infections but not mold infections. In the second 11 studies, the investigators found that all-cause mortality was lower among outpatients (risk ratio, 0.72).

"A randomized controlled trial that assesses the additional value of air quality control including high-efficiency particulate air filtration to strict barrier precautions with antibacterial and antifungal prophylaxis is ethical and justified in locations where air filtration is not used or not available for all patients. Trials assessing the importance of sterile or low-bacterial diet are needed," the authors write. "The safety and potential benefit of outpatient management in observational studies calls for the assessment of outpatient versus inpatient management of hematopoietic stem-cell transplantation in randomized controlled trials."

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