Antibiotic prophylaxis for patients with newly diagnosed multiple myeloma: Systematic review and meta-analysis
Ghulam Rehman Mohyuddin1, Muhammad Aziz2, Brian McClune3
1Kansas University Medical Center, Westwood, Kansas.
Objective:
Ascertain the benefit of prophylactic antibiotics for patients with newly diagnosed multiple myeloma (MM), given that clinical trials evaluating this have had conflicting results.
Methods:
We performed a systematic review and meta-analysis evaluating the use of prophylactic antibiotics in patients with MM and its impact on infection risk and mortality.
Results:
Across three included studies, a total of 664 patients received antibiotics and 650 patients received no antibiotics. The overall incidence of infection within 3 months was lower for antibiotic group compared to placebo (18.4% vs 23.4%, RR: 0.79, 95% CI 0.62-1.00, P = .05, I2 = 6.5%). There was no difference in mortality in the first 3 months (1.5% vs 3.5%, RR: 0.47, 95% CI 0.17-1.27, P = .60, I2 = 28.1%).
Conclusion:
Antibiotic prophylaxis for a finite duration can decrease the overall incidence of infection within the first 3 months following diagnosis. This does not lead to a decrease in mortality. Further data on antibiotic resistance patterns, toxicity, healthcare expenditures, and the impact of antibiotics on subsequent therapies can assist providers in helping make decisions on prophylactic antibiotics with their patients.
Insights
Prophylactic antibiotics for multiple myeloma (MM) patients can reduce infection risk within three months but do not impact mortality. Further research is needed to guide clinical decisions.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Multiple myeloma (MM) is a hematologic malignancy associated with an increased risk of infection.
- Conflicting clinical trial results exist regarding the efficacy of prophylactic antibiotics in MM patients.
- Infection remains a significant cause of morbidity and mortality in newly diagnosed MM.
Purpose of the Study:
- To systematically review and meta-analyze the benefit of prophylactic antibiotics in patients with newly diagnosed multiple myeloma.
- To evaluate the impact of prophylactic antibiotics on infection risk and mortality in MM patients.
Main Methods:
- Systematic review and meta-analysis of relevant clinical trials.
- Inclusion of studies comparing prophylactic antibiotics versus placebo in MM patients.
- Statistical analysis of infection incidence and mortality rates.
Main Results:
- Three studies with a total of 1314 patients were included.
- A lower incidence of infection within 3 months was observed in the antibiotic group (18.4%) compared to placebo (23.4%).
- No significant difference in 3-month mortality was found between the antibiotic and placebo groups.
Conclusions:
- Finite-duration prophylactic antibiotics can decrease infection incidence in early MM management.
- Prophylactic antibiotics do not appear to reduce mortality in the short term.
- Further data on resistance, toxicity, cost, and impact on subsequent therapies are crucial for clinical decision-making.
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