For patients with newly diagnosed multiple myeloma (MM), the use of prophylactic antibiotics soon after diagnosis shows a trend of reducing infection risk, but it appears to have no effect on mortality, according to a recent pooled analysis published in the European Journal of Haematology.

In this meta-analysis of 3 randomized, controlled trials, patients with MM were evaluated for 3-month incidences of infection and mortality associated with either antibiotic prophylaxis (n=664) or a lack of antibiotic prophylaxis (control group; n=650).

The 3-month infection incidence was 18.4% among patients given antibiotic prophylaxis and 23.4% for the control group (risk ratio [RR], 0.79 [95% CI, 0.62-1.00]; P =.05). Grade 3 to 4 infections occurred in 8.0% of patients given antibiotic prophylaxis, while the incidence was 14.8% in the control group (P =.08).

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In a subgroup analysis by type of antibiotic, patients receiving prophylaxis with sulfamethoxazole/trimethoprim did not show a significantly different infection rate compared with the control (P =.45). However, fluoroquinolone prophylaxis was associated with a lower infection rate (P =.049).

The 3-month incidence of mortality did not differ statistically between the prophylaxis and control groups, with rates of 1.5% for those given antibiotics and 3.5% for the control (RR, 0.47 [95% CI, 0.17-1.27]; P =.60).

The investigators indicated that prophylactic antibiotics given during the first 2 to 3 months after MM diagnosis may reduce the incidence of infection at 3 months postdiagnosis. However, they noted that this result was marginal in terms of statistical significance and that the risk of mortality appeared unaffected by antibiotic prophylaxis.


Mohyuddin GR, Aziz M, McClune B, Abdallah AO, Qazilbash M. Antibiotic prophylaxis for patients with newly diagnosed multiple myeloma: systematic review and meta-analysis [published online December 27, 2019]. Eur J Haematol. doi: 10.1111/ejh.13374