Chemotherapy for germ cell tumours: prophylactic ciprofloxacin reduces the incidence of neutropenic fever.

To assess the value of prophylactic ciprofloxacin in reducing the incidence of neutropenic fever in men receiving intensive chemotherapy for germ cell tumours, we reviewed the case notes of 88 consecutive patients treated between January 1986 and December 1992. Nadir blood counts were performed in all patients on day 14. From 1989, prophylactic ciprofloxacin 250 mg b.d. was started when the neutrophil count was less than 1 x 10(9)/l and then prescribed for all subsequent courses of chemotherapy from day 7 to day 21. In total, 88 men received 429 courses of chemotherapy. Prophylactic ciprofloxacin was prescribed for 168 courses. This was associated with a trend towards reducing the risk of admission per course of chemotherapy from 8% (20/261) to 4% (6/168) (P = 0.08). WHO grade 3/4 neutropenia (< 1 x 10(9)/l) was documented for 240 (56%) courses of chemotherapy. The incidence of fever in these patients was significantly reduced from 15% (20/131) to 5% (6/109) (P = 0.02) with prophylactic ciprofloxacin. Two patients, one of whom had received prophylactic ciprofloxacin, died of chest infection confirmed on post-mortem. The results of this non-randomized, retrospective study suggest that prophylactic ciprofloxacin 250 mg b.d. is effective in reducing the incidence of fever complicating neutropenia during chemotherapy for germ cell tumours. To be cost effective, it should be given only to neutropenic patients.