Ofloxacin versus trimethoprim-sulfamethoxazole for prevention of infection in patients with acute leukemia and granulocytopenia.
In a prospective randomized study we evaluated the efficacy and safety of oral ofloxacin (dosage: 200 mg three times daily) versus trimethoprim-sulfamethoxazole (dosage: 960 mg three times daily) as antibacterial prophylaxis in 128 patients with acute leukemia who received aggressive cytotoxic chemotherapy and were granulocytopenic for a median duration of 30 days. Fewer patients receiving ofloxacin were colonized by Enterobacteriaceae (13% versus 90%, p less than 0.001) and Pseudomonas aeruginosa (3% versus 14%, p = 0.025), and developed gram-negative bacterial infection (4% versus 26%, p = 0.002), whereas the incidence of gram-positive bacterial (19% versus 22%) and fungal (7% versus 14%) infections was similar in both groups. Ofloxacin was significantly better tolerated than trimethoprim-sulfamethoxazole, and shortened the duration of fever (p = 0.02) and of parenteral antimicrobial therapy for presumed or documented acquired infection (p = 0.01). Ofloxacin appears to be a safe, effective, well-tolerated alternative to trimethoprim-sulfamethoxazole for preventing gram-negative infection in acute leukemia, but more effective prophylaxis of gram-positive infections is still needed.
Kern
W
W
Medizinische Universitätsklinik, Ulm, Germany.
Kurrle
E
E
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000150:complications*; D001424:Bacterial Infections / Q000517:prevention & control*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011446:Prospective Studies; D012074:Remission Induction; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015242:Ofloxacin