A Cochrane review included 2 RCTs with a total of 195 subjects with solid tumours. The trials compared antibiotics to granulocyte colony stimulating factors (G-CSF) for infection prophylaxis during chemotherapy. 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. However, in another trial the antibiotic group received much lower chemotherapy dose intensity than in the G-CSF group, which may explain the increased incidence of infections in the latter group.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), imprecise results (limited study size for each comparison) and study limitations (lack of allocation concealment, failure to adhere to an intent-to-treat analysis).