Table 5.4GRADE profile: Is primary prophylaxis with quinolone more effective than primary prophylaxis with cotrimoxazole at improving outcomes in patients at risk of neutropenic sepsis

Quality assessmentNo of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsCiprofloxacin, levofloxacin or ofloxacinCotrimoxazoleRelative
(95% CI)		Absolute
Mortality
6randomised trialsserious1no serious inconsistencyno serious indirectnessserious2,3none26/372 (7%)17/317
(5.4%)		RR 1.24
(0.57 to 2.67)		13 more per 1000 (from 23 fewer to 90 more)LOW
Febrile neutropenia (ciprofloxacin vs TMP-SMZ studies)
3randomised trialsserious4no serious inconsistencyno serious indirectnessserious2,3none161/219 (73.5%)143/212
(67.5%)		RR 1.34
(0.88 to 2.04)		229 more per 1000 (from 81 fewer to 702 more)LOW
Febrile neutropenia (levofloxacin vs TMP-SMZ studies) - not reported
0-----none----
Febrile neutropenia (ofloxacin vs TMP-SMZ studies)
3randomised trialsserious5no serious inconsistencyno serious indirectnessserious2none65/142 (45.8%)84/131
(64.1%)		RR 0.39
(0.23 to 0.67)		391 fewer per 1000 (from 212 fewer to 494 fewer)LOW
Colonisation with bacteria resistant to the antibiotic used for prophylaxis
2randomised trialsserious6no serious inconsistencyno serious indirectnessserious2none39/98 (39.8%)58/86
(67.4%)		RR 0.58
(0.44 to 76)		283 fewer per 1000 (from 378 fewer to 1000 more)LOW
Infection with bacteria resistant to the antibiotic used for prophylaxis
3randomised trialsserious6no serious inconsistencyno serious indirectnessvery serious7none3/100 (3%)6/100 (6%)RR 0.24
(0.08 to 0.77)		46 fewer per 1000 (from 14 fewer to 55 fewer)VERY LOW
Quality of life - not reported
0-----none----
Length of hospital stay - not reported
0-----none----
1

1/6 trials had adequate allocation concealment, 1/6 had double blinding

2

Low number of events

3

95% confidence interval around the pooled estimate of effect includes both no effect and appreciable benefit or appreciable harm.

4

1/3 had adequate allocation concealment, 1/3 had double blinding

5

No allocation concealment or blinding

6

1 trial had adequate allocation concealment, none had double blinding

7

Very low number of events

From: 5, Reducing the risk of septic complications of anticancer treatment

Cover of Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients
Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients.
NICE Clinical Guidelines, No. 151.
National Collaborating Centre for Cancer (UK).
Copyright © National Collaborating Centre for Cancer, 2012.

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