Infection prevention in severely myelosuppressed patients: a comparison between ciprofloxacin and a regimen of selective antibiotic modulation of the intestinal flora.
OBJECTIVE
To study whether oral ciprofloxacin would be as effective in preventing bacterial infections in severely myelosuppressed patients as selective antibiotic modulation of the gut flora with neomycin/polymyxin B sulfate/nalidixic acid (NPN).


METHODS
One hundred and five patients undergoing allogeneic or autologous bone marrow transplant, or induction therapy for acute leukemia in 1988 and 1989 were studied. Patients were stratified according to the type of therapy, and randomized in a ratio of 2:1 to either oral ciprofloxacin 500 mg BID, or a combination of oral neomycin 250 mg QID, polymyxin-B 100 mg QID, and oral nalidixic acid 1,000 mg BID. Treatment began on admission and continued until the absolute granulocyte count was greater than 500/mm3 for 3 consecutive days.


RESULTS
The 96 evaluable patients were evenly distributed over the 3 treatment groups; 63 patients received ciprofloxacin and 33 received NPN. Fever developed in 92% of patients on ciprofloxacin and in 97% of patients on NPN. (P = 0.66), 6.6 +/- 5.8 and 7.2 +/- 5.3 days from the start of prophylaxis, respectively. Twenty-five patients on ciprofloxacin developed 29 microbiologically documented infections, fewer than the 26 infections in the 22 patients on NPN (P = 0.02). Patients on ciprofloxacin had fewer bacteremias (33%) than did the NPN patients (55%) (P = 0.05). Gram-negative bacteremias were very rare (2 cases; no Enterobacteriaceae), but streptococcal bacteremias were frequent in both arms (27 cases). Side effects were not significantly different, but compliance with ciprofloxacin was better.


CONCLUSIONS
Ciprofloxacin is at least as effective as the combination of neomycin/polymyxin/nalidixic acid in the prophylaxis of bacterial infections in myelosuppressed patients, and is better tolerated. Additional agents to prevent streptococcal infections are needed.
Jansen
J
J
Methodist Hospital of Indiana, Indianapolis 46202.
Cromer
M
M
Akard
L
L
Black
J R
JR
Wheat
L J
LJ
Allen
S D
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D001855:Bone Marrow Diseases / Q000150:complications* / Q000209:etiology; D002939:Ciprofloxacin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006098:Granulocytes / Q000187:drug effects; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000382:microbiology; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009268:Nalidixic Acid / Q000008:administration & dosage; D009355:Neomycin / Q000008:administration & dosage; D010349:Patient Compliance; D011112:Polymyxin B / Q000008:administration & dosage; D016896:Treatment Outcome
D009268:Nalidixic Acid; D002939:Ciprofloxacin; D009355:Neomycin; D011112:Polymyxin B