A retrospective audit into the prophylactic use of antibiotics in patients receiving chemotherapy for lung cancer
Crockett, Cathryn Nillegoda, Hasanthi Ooi, Kai Yun Harris, Maggie A
Crockett, Cathryn
Nillegoda, Hasanthi
Ooi, Kai Yun
Harris, Maggie A
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Abstract
Introduction: Patients with lung cancer are highly susceptible to
infections due to their underlying malignancy and smoking-related
comorbidities (e.g. COPD). Myelosuppressive chemotherapy use
increases their risk and can result in hospitalisation, subsequent
treatment disruption and even death. Prescribing prophylactic
antibiotics (PA) following chemotherapy has been proposed as a
strategy to mitigate this. Current literature reports that they are
particularly beneficial in reducing morbidity in ‘high risk’ patients
– those expected to have grade 4 neutropenia for >7-10 days
(Kardas and Buraczewska, 2016). However concerns have been
expressed around potential risks of allergic reactions, Clostridium
Difficile infection and the development of antibiotic resistance.
The Christie introduced a departmental guideline in 2009 outlining
recommendations for PA use in this setting (Fig. 1). A local audit in
2010 showed only 54% compliance. Consequently, PA has begun to
be routinely incorporated into relevant chemotherapy regimens on
the electronic prescribing system.
Methods: A re-audit was carried out in 2020. We identified and
reviewed the notes of all patients diagnosed with lung cancer who
received chemotherapy in September 2019.
Results: Of 103 patients, 89 (86.4%) received PA including all
patients with small cell lung cancer and all receiving concurrent
chemoradiotherapy, regardless of histology. Eight (7.7%) patients
had infections following cycle one and a further nine (8.7%)
had infections following later cycles but only one patient was
subsequently prescribed PA. In total, 79 of 96 eligible patients
received PA meaning compliance was 82.3%. Reasons for withholding
PA were poorly documented. No PA related adverse events were
reported.
Conclusion: Compliance with the departmental PA policy has
greatly improved compared to the previous audit but prescribing
in subsequent cycles for patients who have had infections was still
poor and needs to be addressed. The lack of PA associated toxicity
justifies our incorporation of routine PA into specific chemotherapy
regimens
Affiliation
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Crockett C, Nillegoda H, Ooi KY, Harris M. A retrospective audit into the prophylactic use of antibiotics in patients receiving chemotherapy for lung cancer. Lung Cancer . 2021 Jun;156:S34.