Antibacterial prophylaxis in patients with neutropenia

Nishma Singhal, MD, is an associate professor of medicine in the Faculty of Health Sciences and assistant dean for Continuing Health Sciences Education at McMaster University.

When should patients with neutropenia receive antibiotics for infection prevention? Which agents and regimens should be used? Should antibiotics be used in patients with extreme non–chemotherapy-induced neutropenia who are not more prone to infections than the general population?

The greatest data for the use of prophylactic antibacterials is with the use of fluoroquinolones in patients who have an anticipated prolonged neutropenic period of >7 to 10 days that generally involves hematological malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndrome, and patients who might be undergoing bone marrow transplant. The caveat to that is that fluoroquinolone prophylaxis does also subsequently increase fluoroquinolone resistance.

There’s very little data on patients who have idiopathic neutropenia. They certainly are less prone to infections, and so generally prophylactic antibiotics are not recommended, but early prompt treatment in patients presenting with fever or sepsis is certainly recommended.