BACKGROUND Prophylaxis with fluoroquinolones (FQ) is commonly used in patients with acute leukemia (AL) during neutropenia. This practice is supported by an older meta-analysis reporting reduced mortality using FQ prophylaxis. Later meta-analyses have failed to reproduce this finding, presumably due to higher background FQ resistance rates limiting their effectiveness. SUMMARY This article reviews the pros and cons of FQ prophylaxis mainly in patients with AL. Most current guidelines do not support universal prophylaxis but rather recommend a selective approach, weighing the benefits against the risks. This recommendation is based on the lack of mortality benefit reported in more recent meta-analyses. FQ prophylaxis was demonstrated to reduce bacteremia and febrile neutropenia episodes, although mostly in trials performed in low-resistance settings (<20%), whereas current FQ resistance rates may reach 30-60%. Other disadvantages of FQ include potential adverse events, antibiotic resistance development, cost, increase in Gram-positive infections and resistant Gram-negative infections following prophylaxis, Clostridioides difficile infection, and an effect on gut microbiota. KEY MESSAGES Taking the above into consideration, alternative approaches other than universal FQ prophylaxis should be considered. Centers with high FQ resistance rates may consider either withholding prophylaxis or providing selective prophylaxis for high-risk patients screened negative for FQ-resistant bacteria.

中文翻译：

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传统化疗或造血干细胞移植治疗急性白血病期间的氟喹诺酮预防 - 优点和缺点。


背景技术氟喹诺酮类药物（FQ）的预防通常用于中性粒细胞减少症期间的急性白血病（AL）患者。这一做法得到了一项较早的荟萃分析的支持，该分析报告称使用 FQ 预防可降低死亡率。后来的荟萃分析未能重现这一发现，可能是由于较高的背景 FQ 耐药率限制了其有效性。总结 本文主要回顾了 FQ 预防在 AL 患者中的利弊。目前大多数指南并不支持普遍预防，而是建议采取选择性方法，权衡利弊。该建议是基于最近的荟萃分析中报告的缺乏死亡率益处。 FQ 预防被证明可以减少菌血症和发热性中性粒细胞减少症发作，尽管大多数试验是在低耐药环境 (<20%) 中进行的，而目前 FQ 耐药率可能达到 30-60%。 FQ 的其他缺点包括潜在的不良事件、抗生素耐药性的发展、成本、预防后革兰氏阳性菌感染和耐药性革兰氏阴性菌感染的增加、艰难梭菌感染以及对肠道微生物群的影响。关键信息 考虑到上述情况，应考虑普遍 FQ 预防以外的替代方法。 FQ 耐药率高的中心可能会考虑对 FQ 耐药菌筛查呈阴性的高危患者停止预防或提供选择性预防。