Abstract
This study examines the effectiveness of prophylactic ciprofloxacin and rifampin following high-dose chemotherapy and autologous stem cell rescue (HDC/ASCR). Specific endpoints included the incidence of fever, clinically documented infection, bacteremia, and readmission rates from an outpatient bone marrow transplant setting following infection or fever. A group of 97 patients receiving 134 cycles of HDC/ASCR were studied. Patients were given ciprofloxacin 750 mg p.o. twice daily and rifampin 300 mg p.o. twice daily beginning on the day of stem cell reinfusion (24-48 h after completion of high-dose chemotherapy). Most patients were either discharged to an outpatient setting following completion of their chemotherapy or received all of their chemotherapy in an outpatient setting. Febrile neutropenia was treated with empirical antibiotics in an outpatient setting unless it was complicated by hypotension, renal failure, severe mucositis or other problems. The median duration of neutropenia (absolute neutrophil count below 500/mm3) was 7 days. Neutropenic fever occurred in 62% of patients but clinically documented bacterial infection occurred in only 2 (1.5%) patients during their neutropenic period. No bacteremia was noted. Readmission to the hospital following fever or infection occurred in 26% of patients maintained in the outpatient setting. There were no deaths from a bacterial infection in this study although 1 patient (0.7%) died from aspergillosis. Prophylactic ciprofloxacin and rifampin is a well-tolerated and highly effective combination that effectively decreases the risk of both gram-positive and gram-negative bacterial infection following HDC/ASCR. It facilitates outpatient management of myelosuppressed patients receiving autologous stem cell rescue.
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References
Arning M, Wolf HH, Aul C, Heyll A, Scharf RE, Schneider W (1990) Infection prophylaxis in neutropenic patients with acute leukaemia - a randomized, comparative study with ofloxacin, ciprofloxacin and co-trimoxazole/colistin. J Antimicrob Chemother 26 [Suppl D]:137–142
Attal M, Schlaifer D, Rubie H, Huguet F, Charlet J-P, Bloom E, Lemozy J, Massip P, Pris J, Laurent G (1991) Prevention of gram-positive infections after bone marrow transplantation by systemic vancomycin: a prospective, randomized trial. J Clin Oncol 9:865–870
Broun ER, Wheat JL, Kneebone PH, Sundblad K, Hromas RA, Tricot G (1994) Randomized trial of the addition of gram-positive prophylaxis to standard antimicrobial prophylaxis for patients undergoing autologous bone marrow transplantation. Antimicrob Agents Chemother 38:576–579
Dekker AW, Rozenberg-Arska M, Verhoef J (1987) Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med 106:7–12
Donnelly JP, Muus P, Horrevorts AM, Sauerwein RW, Pauw BE de (1993) Failure of clindamycin to influence the course of severe oromucositis associated with streptococcal bacteraemia in allogeneic bone marrow transplant recipients. Scand J Infect Dis 25:43–50
Gilbert C, Meisenberg B, Vredenburgh J, Ross M, Hussein A, Perfect J, Peters WP (1994) Sequential prophylactic oral and empiric once-daily parenteral antibiotics for neutropenia and fever after high-dose chemotherapy and autologous bone marrow support. J Clin Oncol 12:1005–1011
GIMEMA Infection Program (1991) Prevention of bacterial infection in neutropenic patients with hematologic malignancies. A randomized, multicenter trial comparing norfloxacin with ciprofloxacin. Ann Intern Med 115:7–12
Hooper DC, Wolfson JS (1991) Fluoroquinolone antimicrobial agents. N Engl J Med 324:384–394
Karp JE, Merz WG, Hendricksen C, Laughon B, Redden T, Bamberger BJ, Bartlett JG, Saral R, Burke PJ (1987) Oral norfloxacin for prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia. Ann Intern Med 106:1–7
Meisenberg B, McMillan R, Miller W (1995) Sequential cycles of high-dose chemotherapy (HDC) with autologous peripheral blood progenitor cells (PBPC) (abstract). Proc ASCO 14:318
Momin F, Chandrasekar PH (1995) Antimicrobial prophylaxis in bone marrow transplantation. Ann Intern Med 123:205–215
Pizzo PA (1995) Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323–1332
Schimpff SC, Greene WH, Young VM, Fortner CL, Jepsen L, Cusack N, Block JB, Wiernik PH (1975) Infection prevention in acute nonlymphocytic leukemia. Laminar air flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 82:351–358
Teinturier C, Hartmann O, Lemerle J, Benhamou E, Maraninchi D (1995) Prevention of gram-positive infections in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomized controlled trial of vancomycin. Pediatr Hematol Oncol 12:73–77
Wimperis JZ, Baglin TP, Warren RE (1991) An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts. Bone Marrow Transplant 8:363–367
Young LS (1988) Antimicrobial prophylaxis in the neutropenic host: lessons of the past and perspectives for the future. Eur J Clin Microbiol Infect Dis 7:93–97
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Presented in part as an invited lecture at the 7th International Symposium: Supportive Care in Cancer, Luxembourg, 20–23 September 1995
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Meisenberg, B., Gollard, R., Brehm, T. et al. Prophylactic antibiotics eliminate bacteremia and allow safe outpatient management following high-dose chemotherapy and autologous stem cell rescue. Support Care Cancer 4, 364–369 (1996). https://doi.org/10.1007/BF01788843
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DOI: https://doi.org/10.1007/BF01788843