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Efficacy of fluoroquinolone prophylaxis during induction phase in children with acute lymphoblastic leukemia: a

Maria Clara Landivar1, Isabela Hartmann Rost2, Ana Carvalho Kilson3

  • 1Universidad San Francisco de Quito, Quito, Ecuador. mclaralandivar@gmail.com.

European Journal of Pediatrics
|May 1, 2026
PubMed

Insights

Fluoroquinolone prophylaxis during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL) significantly lowers the risk of febrile neutropenia (FN) and bloodstream infections (BSI). This infection prevention strategy does not increase C. difficile risk, potentially improving treatment tolerance.

Area of Science:

  • Pediatric Oncology
  • Infectious Disease Prevention
  • Hematology

Background:

  • Febrile neutropenia (FN) and bloodstream infections (BSI) are significant causes of morbidity and mortality in pediatric acute lymphoblastic leukemia (ALL) patients undergoing induction chemotherapy.
  • Previous studies on fluoroquinolone prophylaxis in this population have yielded inconsistent results, often limited by heterogeneous patient groups and a lack of focus on the induction phase.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy of fluoroquinolone prophylaxis specifically during the induction chemotherapy phase for pediatric ALL.
  • To assess the impact of fluoroquinolone prophylaxis on febrile neutropenia, bloodstream infections, Clostridioides difficile infection (CDI), and all-cause mortality (ACM).

Main Methods:

  • A systematic literature search was conducted across PubMed, Scopus, and Cochrane databases for randomized controlled trials and observational studies.
  • Random-effects meta-analysis was employed to pool data from 7 included studies involving 991 pediatric ALL patients.
  • Primary outcome was FN; secondary outcomes included BSI, CDI, and ACM.

Main Results:

  • Fluoroquinolone prophylaxis was associated with a significant reduction in the risk of FN (OR 0.44; 95% CI 0.33-0.59) and BSI (OR 0.50; 95% CI 0.32-0.81).
  • No significant increase in the risk of Clostridioides difficile infection (CDI) (OR 0.43; 95% CI 0.00-42.30) or all-cause mortality (ACM) (OR 1.04; 95% CI 0.20-5.38) was observed.
  • The protective effect on FN and BSI was consistent across different study designs.

Conclusions:

  • Fluoroquinolone prophylaxis during induction chemotherapy for pediatric ALL effectively reduces the incidence of FN and BSI.
  • The use of fluoroquinolones in this context does not appear to elevate the risk of CDI.
  • Reducing infectious complications through fluoroquinolone prophylaxis may improve treatment tolerance and outcomes in pediatric ALL patients.

Keywords:
Bloodstream infectionsFebrile neutropeniaFluoroquinolone prophylaxisInduction chemotherapyMeta-analysisPediatric acute lymphoblastic leukemia

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