title: Intensified prophylaxis of febrile neutropenia with ofloxacin plus rifampin during severe short-duration neutropenia in patients with lymphoma.
abstract: To analyse the impact of intensified prophylaxis with ofloxacin plus rifampin (O+R) in neutropenic patients we used this combination in 40 consecutive cycles of ifosfamide, cytarabine, prednisolone and etoposide (IAPVP-16). This salvage chemotherapy regimen for lymphoma usually produces four to six days of severe neutropenia without significant extrahematologic toxicities. We compared the infectious morbidity during neutropenia under O+R with 58 consecutives cycles using either norfloxacin or no prophylaxis (control group). Fifty-three percent of control group patients and 20% of the O+R group developed febrile neutropenia that required hospital admission (p<0.001, 95% CI for the difference between both proportions of 16% to 51%). Bacteremia was documented in two patients in the O+R group and six in the control group (p=0.08). Gram-positive cocci (GPC) accounted for all six bacteremias in the control group, while both cases in O+R group were due to a quinolone-resistant gram-negative bacteria (GNB) (p<0.01 for GPC). Five patients (13%) who received O+R and 23 (40%) in control group developed fever of unknown origin, p<0.001, while the total duration of hospitalization due to febril neutropenia was 42 days and 158 days, respectively (p<0.001). In conclusion, intensified prophylaxis with O+R appears to reduce the rate of febrile neutropenia and GPC bacteremia in patients with short and severe neutropenia, which translates into a reduction in the need for hospitalization.
authors.affiliation: Division of Clinical Hematology, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Muñoz
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.forename: M
authors.initials: M
authors.lastname: Subirà
authors.forename: S
authors.initials: S
authors.lastname: Brunet
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.forename: J
authors.initials: J
authors.lastname: Sierra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications / Q000517:prevention & control; D002330:Carmustine / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D005047:Etoposide / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000150:complications / Q000382:microbiology* / Q000517:prevention & control*; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007902:Length of Stay; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy; D015242:Ofloxacin / Q000627:therapeutic use*; D009894:Opportunistic Infections / Q000150:complications / Q000517:prevention & control*; D012293:Rifampin / Q000627:therapeutic use*; D016879:Salvage Therapy / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D005047:Etoposide; D003520:Cyclophosphamide; D015242:Ofloxacin; D002330:Carmustine; D012293:Rifampin