Oral Norfloxacin for Prevention of Gram-Negative Bacterial Infections in Patients with Acute Leukemia and Granulocytopenia

Karp, Judith E.; Merz, William G.; Hendricksen, Carol; Laughon, Barbara E.; Redden, Teresa; Bamberger, Brian J.; Bartlett, John G.; Saral, Rein; Burke, Philip J.

doi:10.7326/0003-4819-106-1-1

Cited by 218 publications

(88 citation statements)

References 32 publications

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“…We have updated our meta-analysis 1 with data from recent trials 2,3 and divided the trials [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] according to the type of patient (Fig. 1).…”

Section: Which Patients Should Be Offered Antibiotic Prophylaxis?mentioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

177

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New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. For patients with acute leukemia or those who undergo bone marrow transplantation, prophylaxis with fluoroquinolones diminished the risk of death from any cause by 33% (95% confidence interval [95% CI], 2-54%). Thus, 55 patients who have acute leukemia or who undergo bone marrow transplantation must receive prophylaxis to prevent 1 death. In 4 studies that included patients with solid tumors or lymphoma, prophylaxis reduced the rate of death during the first month (relative risk, 0.51; 95% CI, 0.27-0.97), and 82 patients had to receive prophylaxis to prevent 1 death. The main argument brought against prophylaxis is the induction of resistance. Patients who received prophylaxis did not experience more infections caused by resistant strains than patients in the control group. The recent GIMEMA study was con- N ew evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. A systematic review and meta-analysis of randomized controlled trials 1 demonstrated that death from all causes was reduced by 34% (95% confidence interval [95% CI], 21-45%) in neutropenic patients who received any antibiotic prophylaxis and by 40% (95% CI, 17-56%) in patients who received quinolones for prophylaxis. in addition, the occurrence of febrile episodes and bacterial infections decreased significantly (Table 1). Most of the studies that were included in that meta-analysis addressed patients with hematologic malignancies. In the most recent and largest randomized controlled trial that included patients in whom neutropenia was expected to occur for more than 7 days (mainly with acute leukemia and autologous peripheral blood stem cell transplantation), 2 patients who received levofloxacin as prophylaxis had a relative risk (RR) of 0.54 (95% CI, 0.25-1.16) for mortality compared with the placebo group: a Dr. Cullen has received honoraria from Sanofi Aventis.We thank Dr. Vivianne Tjan-Heijnen and Ms. Muriel Debois for supplying us with full data regarding mortality from their study.

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Section: Which Patients Should Be Offered Antibiotic Prophylaxis?mentioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

177

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“…9,10 The use of prophylactic antibiotics, especially during periods of neutropenia and chronic GVHD, as well as shorter time to engraftment with the use of peripheral stem cells, has decreased the incidence of gram-negative bacteremia from rates of 30-40% in the 1980s to rates of approximately 10-20% more recently. 2,[11][12][13][14] Pseudomonas aeruginosa accounts for a minority of bacteremic episodes in patients undergoing HCT 3,6,15 but is the most common pathogen isolated in bacterial pneumonia occurring before day 100 post-transplant. 4 Owing to antibiotic resistance, it can be difficult to treat 16 and in addition, the colonization of sites such as the lung and gastrointestinal tract may lead to relapse of infection once antibiotics are discontinued.…”

Section: Introductionmentioning

confidence: 99%

Invasive Pseudomonas aeruginosa infections: high rate of recurrence and mortality after hematopoietic cell transplantation

Hakki

Limaye

Kim

et al. 2007

Bone Marrow Transplant

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Limited data exist regarding the incidence and factors associated with outcome of invasive Pseudomonal infections in hematopoietic cell transplant (HCT). A retrospective analysis of cases of invasive Pseudomonas aeruginosa infection and factors associated with outcome was performed. P. aeruginosa invasive infection occurred in 95 of 5772 patients (1.65%) a median of 63 days after HCT (range 5-1435). Only 28% of infections occurred during periods of neutropenia (absolute neutrophil counto500 cells/mm 3 ). Infection-attributable mortality during the initial episode of infection was 35.8%. Factors associated with initial mortality included the presence of a copathogen and high-dose steroid use. Ten (16.4%) of those who survived the initial infection experienced a recurrence of P. aeruginosa infection at a median of 9 days (range 3-17) after stopping antibiotics and 60% of those died as a result of recurrent infection a median of 1 day (range 1-7) after onset of recurrence. Grade 3-4 graft-versus-host disease was associated with a higher risk of recurrent infection. The risk of recurrence was not influenced by the presence of copathogens. Thus, invasive P. aeruginosa infections are associated with high recurrence rates and mortality in this immunocompromised population. Aggressive attempts to reduce immunosuppression and to treat copathogens may help during the initial infection.

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“…There maybe other reasons for the very good results of the present study, such as the facts that norfloxacin has a broad antimicrobial spectrum, is poorly absorbed in spite of its high concentration in the gastrointestinal tract, and preserves colonization resistance. Although we didn't have enough data on the surveillance culture and bacteria resistant to norfloxacin, previous reports showed a low prevalence of norfloxacinresistant aerobic bacteria in stool specimens obtained throughout the course of granulocytopenia and indicated that such bacteria appeared to be independent of norfloxacin administration (7,8). Acquired infections in the norfloxacin group were not refractory to the empirical antibiotic treatment, and norfloxacin had no impact on the frequency of gram-positive (including MRSA, Methicillin resistant Staphylococcus aureus) bacterial infections in the present study or in the study of Karp et al (8).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, gram-negative bacterial infections occurred significantly less often in the norfloxacin-treated group (0% to 1 1.4%) (6)(7)(8) compared with the control group (24%, 39%) (7,8) and the group which received non-absorbable antibiotics (16.7%) (6). In the report of Karp et al (8), the mean number of days from starting the chemotherapy to the first febrile episode was longer in the norfloxacin group, and the meannumberof days with a fever during the study period was lower in the norfloxacin group compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of Bacterial and Fungal Infections in Acute Leukemia Patients: A New and Potent Combination of Oral Norfloxacin and Amphotericin B.

1993

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The effect of a combination regimen using norfloxacin (NFLX)and amphotericin B (AMPH-B) for prevention ofinfections in patients with acute leukemia being treated by remission-induction chemotherapy in a randomized, controlled trial was studied. One hundred and six consecutive, evaluable patients were randomly assigned to receive orally 200 mg of norfloxacin two or four times daily and 200 mg of amphotericin B four times daily, or amphotericin B only. A smaller percentage of patients with bacteriologically-documented infections was observed in the study group compared with the control group (34.6% vs 56.9%; P<0.05). The mean number of days that the patients received empirical antibiotic therapy was shorter in the study group (23 days vs 30 days; P<0.05). The percentage of patients with a gram-negative bacterial infection (9.6% vs 27.5% ; P<0.05) or a fungal infection (17.3% vs 37.3% ; P<0.05) was decreased in the study group. This newcombination antimicrobial regimen is safe and effective for prevention of gram-negative bacterial as well as fungal infections in patients with acute leukemia being treated with cytotoxic remission-induction chemotherapy. (Internal Medicine 32: 710-715, 1993)

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Oral Norfloxacin for Prevention of Gram-Negative Bacterial Infections in Patients with Acute Leukemia and Granulocytopenia

Cited by 218 publications

References 32 publications

Antibiotic prophylaxis in neutropenic patients

Antibiotic prophylaxis in neutropenic patients

Invasive Pseudomonas aeruginosa infections: high rate of recurrence and mortality after hematopoietic cell transplantation

Prevention of Bacterial and Fungal Infections in Acute Leukemia Patients: A New and Potent Combination of Oral Norfloxacin and Amphotericin B.

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