Experience with prophylactic oral ciprofloxacin in gynecological cancer patients developing severe chemotherapy-induced neutropenia.
The development of significant neutropenia is a relatively frequent complication of cytotoxic chemotherapy of malignant disease. In an effort to develop a cost-effective management strategy to prevent serious infectious events associated with severe chemotherapy-induced neutropenia, patients treated in the Gynecological Oncology Program of the Cleveland Clinic Taussig Cancer Center have been administered ciprofloxacin, a potent broad-spectrum antibiotic, 500 mg orally twice a day, beginning at the time of documentation of grade 4 neutropenia. The antibiotic is continued until granulocyte recovery. A total of 44 patients (57 treatment courses) have been treated in this manner. There have been no complications of therapy and no episodes of subsequent infections due to ciprofloxacin-resistant organisms. Two patients required hospital admission following the development of significant fever, despite the use of ciprofloxacin. While these results are encouraging and suggest that the use of prophylactic ciprofloxacin is a highly cost-effective management approach in this setting, randomized controlled trials are necessary to define the ultimate benefit of this clinical strategy.
Markman
M
M
Department of Hematology/Medical Oncology, The Cleveland Clinic Taussig Cancer Center, Ohio 44195, USA. markmam@ccf.org
Kennedy
A
A
Webster
K
K
Peterson
G
G
Kulp
B
B
Belinson
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002939:Ciprofloxacin