Low bacterial diet versus control diet to prevent infection in cancer patient treated with chemotherapy causing episodes of neutropenia (Review)

Department of Paediatric Oncology, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 09/2012; 9(9):CD006247. DOI: 10.1002/14651858.CD006247.pub2
Source: PubMed


Neutropenia is a potentially serious side effect of chemotherapy and a major risk factor for infections, which can be life-threatening. It has been argued that a low bacterial diet (i.e. food and drinks with low levels of bacteria) can prevent the occurrence of infections and (infection-related) death in cancer patients receiving chemotherapy causing episodes of neutropenia. The review authors identified three randomised studies comparing different diets in 192 children and adults with different types of cancer. Other interventions, such as antimicrobial prophylaxis (i.e. prevention of infections using antimicrobial therapy such as antibiotics) and hygiene practices, and definitions of the different study outcomes also differed between the studies and very limited information on anticancer treatment was given. All studies had methodological problems. Unfortunately, combining the results of the included studies was not possible, but at the moment there is no evidence from individual studies showing that the use of a low bacterial diet prevents infections. Data on survival, time from onset of neutropenia to fever, the duration of empirical (i.e. the start of treatment prior to determination of a definitive diagnosis) antibiotics and antimycotics (i.e. agents that target fungal infections), diet acceptability and quality of life were all evaluated by only one study; for all outcomes no statistically significant differences between the treatment groups was observed. None of the studies evaluated infection-related mortality. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. The reason that no difference between the different diets was identified could, for example, be the result of the low number of patients included in the studies. Based on the currently available evidence, the review authors were not able to give recommendations for clinical practice. More high-quality research is needed.

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Available from: Edith Leclercq, Mar 27, 2015
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