Summary
Background
Bacterial infections are common during induction therapy in children and adolescents
with acute leukaemia and may cause infection-related mortality.
Aim
To determine the efficacy and safety of prophylactic antibiotics in paediatric patients
with acute leukaemia receiving induction chemotherapy.
Methods
From three English databases and four Chinese databases, we searched for randomized
controlled trials (RCTs) and cohort studies that compared prophylactic antibiotics
to placebo, no prophylaxis, or that compared one antibiotic versus another in paediatric
patients with acute leukaemia undergoing induction chemotherapy. Two reviewers independently
screened the studies, extracted data, and assessed the risk of bias using Cochrane
Risk of Bias 2 tool and Newcastle–Ottawa Scale, and the certainty of evidence using
Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Findings
Two RCTs and ten cohort studies were finally included. For children with acute lymphoblastic
leukaemia, antibiotic prophylaxis, including levofloxacin, sulfamethoxazole–trimethoprim,
or other antibiotics, probably reduced bacteraemia (risk ratio (RR): 0.44; 95% confidence
interval (CI): 0.33–0.60; moderate certainty) without significantly increasing Clostridioides difficile infection (CDI) or invasive fungal infection. Levofloxacin reduced the CDI rate (RR:
0.08; 95% CI: 0.01–0.62; high certainty). Ciprofloxacin prophylaxis probably reduced
infection-related mortality (RR: 0.12; 95% CI: 0.01–0.97; moderate certainty). In
children with acute myeloid leukaemia, ciprofloxacin plus vancomycin may reduce febrile
neutropenia (RR: 0.79; 95% CI: 0.66–0.94; low certainty). Individual studies indicated
that prophylaxis increased antibiotic exposure but reduced non-preventive antibiotic
exposure.
Conclusion
In children with acute leukaemia undergoing induction therapy, antibiotic prophylaxis
may improve the bacterial infection and mortality.
Keywords
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Article info
Publication history
Published online: March 13, 2023
Accepted:
March 6,
2023
Received:
November 23,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
