Antibiotic prophylaxis in veterinary cancer chemotherapy: A review and recommendations

Abstract

Bacterial infection following cancer chemotherapy-induced neutropenia is a serious cause of morbidity and mortality in human and veterinary patients. Antimicrobial prophylaxis is controversial in the human oncology field, as any decreased incidence in bacterial infections is countered by patient adverse effects and increased antimicrobial resistance. Comprehensive guidelines exist to aid human oncologists in prescribing antimicrobial prophylaxis but similar recommendations are not available in veterinary literature. As the veterinarian's role in antimicrobial stewardship is increasingly emphasized, it is vital that veterinary oncologists implement appropriate antimicrobial use. By considering the available human and veterinary literature we present an overview of current clinical practices and are able to suggest recommendations for prophylactic antimicrobial use in veterinary cancer chemotherapy patients.

LOPH: a novel chemotherapeutic protocol for feline high-grade multicentric or mediastinal lymphoma, developed in an area endemic for feline leukemia virus

“…The level of evidence for using antibiotics or G-CSF is very low in veterinary patients and recommendations are made based on human guidelines. 44 There is no current specific recommendation for cats. In dogs, prophylactic antibiotics are indicated for neutrophil counts lower than 0.75 × 10 9 /l, but they are not recommended for a neutrophil count higher than 1 × 10 9 /l.…”

“…As performed in this study, prophylactic antibiotic use is also considered in dogs presenting with a neutrophil count of 0.75–1 × 10 9 /l if one or more of the following risk factors are presented: hematologic malignancies, concomitant disease, animals with reduced weight or body size (as in cats) and mutations in the ABCB1 gene (P-glycoprotein). 44,45 Both lymphoma (as a hematopoietic malignancy) and persistent FeLV viremia (as a concomitant disease) may significantly compromise the patient’s immunity. 1,2,4 Antibiotic choice should be based on the sensitivity of the resident pathogenic bacteria.…”

“…1,2,4 Antibiotic choice should be based on the sensitivity of the resident pathogenic bacteria. 44,46 Nevertheless, specific veterinary studies assessing resistance in chemotherapy patients are not available. The antibiotic must have a broad-spectrum efficacy, but anaerobe sparing and additional Gram-positive cover is not recommended.…”

“…The antibiotic must have a broad-spectrum efficacy, but anaerobe sparing and additional Gram-positive cover is not recommended. 44 Ideally, sulfonamides might be used, but they are not well tolerated by cats, and non-halogenated fluoroquinolones (such as norfloxacin or marbofloxacin) appear to represent a safer option, even though we recognize the risk of using tier 2 antibiotics in a prophylactic setting, which might lead to bacterial resistance. 44,47 Treatment duration should be maintained if infection is confirmed or until the neutrophil count is higher than 1 × 10 9 /l, 42 as performed in the present study.…”

“…There is very limited evidence on the use of G-CSF (ie, filgrastim) in cats and its use remains controversial in veterinary patients. 44 In humans, it reduces the duration of grade III and IV neutropenia, and reduces hospitalizations and the need for IV antibiotics. 47 In dogs, it accelerated the recovery and decreased the severity of neutropenias induced by cyclophosphamide.…”