Prophylactic fluoroquinolones in hematopoietic stem cell transplant recipients: A meta-analytic comparison of ciprofloxacin and levofloxacin

Medicine (Baltimore). 2025 May 9;104(19):e42317. doi: 10.1097/MD.0000000000042317.

Abstract

Background: Hematopoietic stem cell transplantation (HSCT) is a critical therapeutic intervention for hematological malignancies. However, infections remain a leading complication. Fluoroquinolones, particularly ciprofloxacin and levofloxacin, are commonly employed as prophylactic agents. This study compares their efficacy in preventing post-HSCT infections.

Methods: A systematic review and meta-analysis were conducted using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Relevant studies comparing ciprofloxacin and levofloxacin in HSCT recipients were identified from biomedical databases. Randomized controlled trials and retrospective cohort studies were included. Data extraction encompassed patient demographics, intervention details, and infection outcomes. Meta-analyses employed RevMan software, using risk ratios (RR) and mean differences with 95% confidence intervals (CI).

Results: Five studies involving 1202 HSCT recipients (597 ciprofloxacin; 605 levofloxacin) were analyzed. Levofloxacin showed superior efficacy in reducing bloodstream infections (BSI) (RR = 1.61; 95% CI: [1.04, 2.49]; P = .03) and specifically gram-positive BSI (RR = 1.60; 95% CI: [1.09, 2.36]; P = .02). Both agents demonstrated similar effectiveness in preventing febrile neutropenia (RR = 0.99; P = .96), gram-negative BSI (RR = 0.99; P = .99), pneumonia (RR = 1.24; P = .7), and all-cause mortality (RR = 1.05; P = .7). Hospital stay duration was also comparable (mean differences = 0.57 days; P = .4).

Conclusions: Levofloxacin is more effective in preventing gram-positive BSIs post-HSCT, while ciprofloxacin offers comparable outcomes in other infection-related parameters. Given its broader bacterial coverage and convenient dosing, levofloxacin may be preferred for prophylaxis. Further large-scale randomized trials are recommended to confirm these findings.

Keywords: ciprofloxacin; hematopoietic stem cell transplant; levofloxacin; meta-analysis; prophylaxis.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Comparative Study

MeSH terms

  • Anti-Bacterial Agents* / therapeutic use
  • Antibiotic Prophylaxis* / methods
  • Ciprofloxacin* / therapeutic use
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Levofloxacin* / therapeutic use
  • Randomized Controlled Trials as Topic

Substances

  • Levofloxacin
  • Ciprofloxacin
  • Anti-Bacterial Agents