Antibiotic prophylaxis for patients with acute leukemia

Chemotherapy directed at acute leukemia (AL) causes predictable periods of neutropenia during which patients are at significant risk for bacterial infection and subsequent infection-related death. In an effort to diminish this risk, several studies have assessed the utility of prophylactic antibiotics during the neutropenic period. While prophylactic antibiotics have been associated with a decrease in the incidence of fever and bacterial infection, no placebo-controlled randomized trial has found a decrease in mortality. In addition, delayed adverse consequences associated with prophylaxis have emerged including increases in both colonization and infection with antimicrobial-resistant and unusual pathogens like quinolone-resistant Escherichia coli. To determine who would benefit most from prophylaxis, the immediate benefits including reduction in fever and infection must be balanced with the potential for emergence of resistant pathogens in this population.