A retrospective audit into the prophylactic use of antibiotics in patients receiving chemotherapy for lung cancer

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