A pilot study of antibiotic cycling in a hematology-oncology unit.
OBJECTIVE
To determine the safety and treatment efficacy of cycling antibiotic regimens for prophylaxis or treatment of patients with profound neutropenia.


METHODS
A prospective, nonrandomized, observational trial.


METHODS
A 20-bed adult hematology-oncology inpatient unit at a university referral hospital.


METHODS
Hospitalized adult patients with chemotherapy- or radiation-induced neutropenia (absolute neutrophil count less than 500 cells/mm3).


METHODS
Between July 1994 and January 1996, 295 hospitalized patients were evaluated on an intent-to-treat basis for the cycling protocol. Of these, 271 were eligible and assigned to one of four antibiotic regimens being used at the time of enrollment: (1) ceftazidime+vancomycin; (2) imipenem; (3) aztreonam+cefazolin; (4) ciprofloxacin+clindamycin. Data on infection rates and types, and antibiotic resistance patterns, toxicity, and effectiveness were collected.


RESULTS
Twenty-four patients were excluded. Of the 271 evaluable patients, 123 (42%) were able to complete treatment on the assigned regimen. Of the 148 patients (50%) unable to do so, the reasons for failure included persistent fever (79%), breakthrough bacteremia (14%), and drug toxicity (7%). The antibiotic susceptibility profiles over the study period showed no increase in resistance. However, there was a marked increase in enterococcal infections.


CONCLUSIONS
Our data show no significant increase in side effects or decrease in efficacy while cycling antibiotics among neutropenic patients and thus support further study of its role.
Dominguez
E A
EA
Department of Medicine, University of Nebraska Medical Center, Omaha, USA.
Smith
T L
TL
Reed
E
E
Sanders
C C
CC
Sanders
W E
WE
D000328:Adult; D000900:Anti-Bacterial Agents; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000008:administration & dosage* / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions; D006405:Hematology; D006748:Hospital Departments; D006801:Humans; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D016522:Oncology Service, Hospital; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects
D000900:Anti-Bacterial Agents