Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy.


BACKGROUND:Febrile neutropenia (FN) and other infectious complications are some of the most serious treatment-related toxicities of chemotherapy for cancer, with a mortality rate of 2% to 21%. The two main types of prophylactic regimens are granulocyte (G-CSF) or granulocyte-macrophage colony stimulating factors (GM-CSF); and antibiotics, frequently quinolones or cotrimoxazole. Important current guidelines recommend the use of colony stimulating factors when the risk of febrile neutropenia is above 20% but they do not mention the use of antibiotics. However, both regimens have been shown to reduce the incidence of infections. Since no systematic review has compared the two regimens, a systematic review was undertaken. OBJECTIVES:To compare the effectiveness of G-CSF or GM-CSF with antibiotics in cancer patients receiving myeloablative chemotherapy with respect to preventing fever, febrile neutropenia, infection, infection-related mortality, early mortality and improving quality of life. SEARCH STRATEGY:We searched The Cochrane Library, MEDLINE, EMBASE, databases of ongoing trials, and conference proceedings of the American Society of Clinical Oncology and the American Society of Hematology (1980 to 2007). We planned to include both full-text and abstract publications. SELECTION CRITERIA:Randomised controlled trials comparing prophylaxis with G-CSF or GM-CSF versus antibiotics in cancer patients of all ages receiving chemotherapy or bone marrow or stem cell transplantation were included for review. Both study arms had to receive identical chemotherapy regimes and other supportive care. DATA COLLECTION AND ANALYSIS:Trial eligibility and quality assessment, data extraction and analysis were done in duplicate. Authors were contacted to obtain missing data. MAIN RESULTS:We included two eligible randomised controlled trials with 195 patients. Due to differences in the outcomes reported, the trials could not be pooled for meta-analysis. Both trials showed non-significant results favouring antibiotics for the prevention of fever or hospitalisation for febrile neutropenia. AUTHORS' CONCLUSIONS:There is no evidence for or against antibiotics compared to G(M)-CSFs for the prevention of infections in cancer patients.


Herbst C,Naumann F,Kruse EB,Monsef I,Bohlius J,Schulz H,Engert A




Has Abstract


2009-01-21 00:00:00








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    abstract:BACKGROUND:Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a pre...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Smith S,Edwards CT

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  • Low protein diets for non-diabetic adults with chronic kidney disease.

    abstract:BACKGROUND:Chronic kidney disease (CKD) is defined as reduced function of the kidneys present for 3 months or longer with adverse implications for health and survival. For several decades low protein diets have been proposed for participants with CKD with the aim of slowing the progression to end-stage kidney disease (...

    journal_title:The Cochrane database of systematic reviews

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    authors: Hahn D,Hodson EM,Fouque D

    更新日期:2020-10-29 00:00:00

  • Trifluoperazine for schizophrenia.

    abstract:BACKGROUND:Trifluoperazine is an inexpensive accessible 'high potency' antipsychotic drug, widely used to treat schizophrenia or related psychoses. OBJECTIVES:To estimate the effects of trifluoperazine compared with placebo and other drugs. SEARCH STRATEGY:Searches of the Cochrane Schizophrenia Group's register of tr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Marques LO,Lima MS,Soares BG

    更新日期:2004-01-01 00:00:00

  • Botulinum toxin type A therapy for cervical dystonia.

    abstract:BACKGROUND:Cervical dystonia is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. In recent years, Botulinum toxin Type A (BtA) has become the first line therapy. However its true efficacy, in particular the potential effect size...

    journal_title:The Cochrane database of systematic reviews

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    authors: Costa J,Espírito-Santo C,Borges A,Ferreira JJ,Coelho M,Moore P,Sampaio C

    更新日期:2005-01-25 00:00:00

  • Methotrexate for maintenance of remission in Crohn's disease.

    abstract:BACKGROUND:Safe and effective long-term treatments that reduce the need for corticosteroids are needed for Crohn's disease. Although purine antimetabolites are moderately effective for maintenance of remission patients often relapse despite treatment with these agents. Methotrexate may provide a safe and effective alte...

    journal_title:The Cochrane database of systematic reviews

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    authors: Patel V,Macdonald JK,McDonald JW,Chande N

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  • Different intensities of glycaemic control for pregnant women with pre-existing diabetes.

    abstract:BACKGROUND:The optimal glycaemic control target in pregnant women with pre-existing diabetes is unclear, although there is a clear link between high glucose concentrations and adverse birth outcomes. OBJECTIVES:To assess the effects of different intensities of glycaemic control in pregnant women with pre-existing type...

    journal_title:The Cochrane database of systematic reviews

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    authors: Middleton P,Crowther CA,Simmonds L,Muller P

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    abstract:BACKGROUND:Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. In unstable COPD patients who have suffered from an exace...

    journal_title:The Cochrane database of systematic reviews

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    authors: Puhan M,Scharplatz M,Troosters T,Walters EH,Steurer J

    更新日期:2009-01-21 00:00:00

  • Hyperfractionated or accelerated radiotherapy for head and neck cancer.

    abstract:BACKGROUND:Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. OBJECTIVES:The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve...

    journal_title:The Cochrane database of systematic reviews

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    authors: Baujat B,Bourhis J,Blanchard P,Overgaard J,Ang KK,Saunders M,Le Maître A,Bernier J,Horiot JC,Maillard E,Pajak TF,Poulsen MG,Bourredjem A,O'Sullivan B,Dobrowsky W,Andrzej H,Skladowski K,Hay JH,Pinto LH,Fu KK,Fallai

    更新日期:2010-12-08 00:00:00

  • Intramedullary nails for extracapsular hip fractures in adults.

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    journal_title:The Cochrane database of systematic reviews

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    authors: Parker MJ,Handoll HH

    更新日期:2006-07-19 00:00:00

  • Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm.

    abstract:BACKGROUND:An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 populatio...

    journal_title:The Cochrane database of systematic reviews

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  • Nutritional support for critically ill children.

    abstract:BACKGROUND:Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children. This is an update of a review that was originally publ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Joffe A,Anton N,Lequier L,Vandermeer B,Tjosvold L,Larsen B,Hartling L

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  • 5-Fluorouracil for glaucoma surgery.

    abstract:BACKGROUND:Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intraocular pressure. The surgery involves creating a channel through the sclera, through which intraocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel, intraocular p...

    journal_title:The Cochrane database of systematic reviews

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    authors: Green E,Wilkins M,Bunce C,Wormald R

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  • Elemene for the treatment of lung cancer.

    abstract:BACKGROUND:Elemene, isolated from the Chinese medicinal herb Rhizoma Zedoariae and be used to treat patients with lung cancer in China. Until now, the effects have not been systematically reviewed. OBJECTIVES:The purpose of this review was to determine the effectiveness and safety of elemene in the treatment of patien...

    journal_title:The Cochrane database of systematic reviews

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    authors: Rui D,Xiaoyan C,Taixiang W,Guanjian L

    更新日期:2007-10-17 00:00:00

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    abstract:BACKGROUND:Patients with type 2 diabetes mellitus (T2D) have an increased risk of cardiovascular disease and mortality compared to the background population. Observational studies report an association between reduced blood glucose and reduced risk of both micro- and macrovascular complications in patients with T2D. Ou...

    journal_title:The Cochrane database of systematic reviews

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    authors: Hemmingsen B,Lund SS,Gluud C,Vaag A,Almdal TP,Hemmingsen C,Wetterslev J

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    abstract:BACKGROUND:As a result of HIV-related mortalities more than 13 million children under the age of 15 have lost a parent due to HIV and AIDS. There are also many children who have HIV-positive parents or primary caregivers; these children are affected by HIV and AIDS and are potentially vulnerable to HIV transmission. Ch...

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    authors: King E,De Silva M,Stein A,Patel V

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    abstract:BACKGROUND:The relative efficacy of fluticasone (FP) and beclomethasone (BDP) propelled with CFCs has been well established. The potency of HFA-BDP is thought to have been improved with new propellant and some studies suggest that it may equipotent at half the dose of CFC propelled-BDP. There is a need to revisit this ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Lasserson TJ,Cates CJ,Jones AB,Steele EH,White J

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  • Blood CEA levels for detecting recurrent colorectal cancer.

    abstract:BACKGROUND:Testing for carcino-embryonic antigen (CEA) in the blood is a recommended part of follow-up to detect recurrence of colorectal cancer following primary curative treatment. There is substantial clinical variation in the cut-off level applied to trigger further investigation. OBJECTIVES:To determine the diagn...

    journal_title:The Cochrane database of systematic reviews

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    abstract:BACKGROUND:Potentially disabling postural headache occurs after dural puncture in 1-70% of patients. It has been suggested that such headaches may be less common if patients routinely have a period of bed rest or receive supplementary fluids after the procedure. OBJECTIVES:To assess the effects on post dural puncture ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Sudlow C,Warlow C

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  • Serenoa repens for benign prostatic hyperplasia.

    abstract:OBJECTIVES:This systematic review aimed to assess the effects of Serenoa repens in the treatment of Benign Prostatic Hyperplasia (BPH). SEARCH STRATEGY:Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, Cochrane Library, Phytodok), by checking bibliographies, and by contacting man...

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    authors: Wilt T,Ishani A,Stark G,MacDonald R,Mulrow C,Lau J

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    abstract:BACKGROUND:Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action pl...

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    authors: Lenferink A,Brusse-Keizer M,van der Valk PD,Frith PA,Zwerink M,Monninkhof EM,van der Palen J,Effing TW

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    abstract:BACKGROUND:Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practise time without increasing staffing. OBJECTIVES:To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH STRATEGY:We searched the Cochrane Stroke G...

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    authors: English C,Hillier SL

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  • Care delivery and self-management strategies for children with epilepsy.

    abstract:BACKGROUND:In response to criticism that epilepsy care for children has little impact, healthcare professionals and administrators have developed various service models and strategies to address perceived inadequacies. OBJECTIVES:To assess the effects of any specialised or dedicated intervention for epilepsy versus us...

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    authors: Fleeman N,Bradley PM

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  • Aromatase inhibitors for subfertile women with polycystic ovary syndrome.

    abstract:BACKGROUND:Polycystic ovary syndrome (PCOS) is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea). It affects about 4% to 8% of women worldwide and often leads to anovulatory subfertility. Aromatase inhibitors (AIs) are a novel class of drugs that were introduced for ovul...

    journal_title:The Cochrane database of systematic reviews

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    authors: Franik S,Kremer JA,Nelen WL,Farquhar C

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  • Thermotherapy for treating rheumatoid arthritis.

    abstract:BACKGROUND:Heat and cold therapy are often used as adjuncts in the treatment of rheumatoid arthritis by rehabilitation specialists. OBJECTIVES:To evaluate the effects of heat and cold on objective and subjective measures of disease activity in patients with rheumatoid arthritis. SEARCH STRATEGY:We searched Medline, E...

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    authors: Welch V,Brosseau L,Shea B,McGowan J,Wells G,Tugwell P

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  • Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants.

    abstract:BACKGROUND:Respiratory failure due to lung immaturity is a major cause of mortality in preterm infants. Although the use of intermittent positive pressure ventilation (IPPV) in neonates with respiratory failure saves lives, its use is associated with lung injury and chronic lung disease (CLD). Conventional IPPV is prov...

    journal_title:The Cochrane database of systematic reviews

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    authors: Henderson-Smart DJ,Cools F,Bhuta T,Offringa M

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  • Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents.

    abstract:BACKGROUND:Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently us...

    journal_title:The Cochrane database of systematic reviews

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    authors: Posner EB,Mohamed K,Marson AG

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  • Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance.

    abstract:BACKGROUND:In areas where intestinal worm infections occur, the World Health Organization recommends treating all school children at regular intervals with deworming drugs to improve growth and school performance. The evidence base for this policy needs to be established for countries to commit resources to implement t...

    journal_title:The Cochrane database of systematic reviews

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  • Topical umbilical cord care at birth.

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    journal_title:The Cochrane database of systematic reviews

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    journal_title:The Cochrane database of systematic reviews

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