Oral ciprofloxacin plus colistin: prophylaxis against bacterial infection in neutropenic patients. A strategy for the prevention of emergence of antimicrobial resistance.
Following a 2-year study, the combination of oral ciprofloxacin and colistin has been used continuously for 10 years without the emergence of resistance. During a 2-year period (1987-1989), we compared ciprofloxacin + colistin (CIP + COL) with neomycin + colistin (NEO + COL) in a randomized trial--combinations chosen because of the potential for prophylaxis of Gram-negative infection by ciprofloxacin, with colistin given to reduce the risk of emergence of resistance. Sixty-four patients with similar demographics in each arm were evaluable for efficacy analysis. Patients on CIP + COL had a significantly lower proportion of neutropenic days with fever (P < 0.001) and neutropenic days on intravenous antibiotics (P < 0.001) than patients on NEO + COL. A total of 54 (15 bacteriologically documented) pyrexial episodes occurred in patients on CIP + COL and 77 (41 bacteriologically documented) in patients on NEO + COL. Only two Gram-negative bacterial infections occurred in the CIP + COL arm compared with 16 in the NEO + COL arm. No Staphylococcus aureus infections occurred in the CIP + COL group compared with 10 in the other patients. Two CIP-resistant Gram-negative bacilli were isolated from patients on CIP + COL compared with 13 NEO-resistant Gram-negative bacilli from patients on NEO + COL. Following a subsequent decade of unchanged use of this prophylactic strategy in neutropenic patients, a 2-year follow-up study between 1 January 1998 and 31 December 1999 showed 66 significant infections during 700 [corrected] neutropenic episodes. Thirty-five of the 111 (31%) isolates were ciprofloxacin-resistant, involving 5% of the neutropenic episodes [corrected].
Prentice
H G
HG
Department of Haematology, Royal Free Hospital and The Royal Free & University College Medical School, Royal Free Campus, London, UK. g.prentice@rfc.ucl.ac.uk
Hann
I M
IM
Nazareth
B
B
Paterson
P
P
Bhamra
A
A
Kibbler
C C
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D016026:Bone Marrow Transplantation; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003091:Colistin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009355:Neomycin / Q000627:therapeutic use; D009503:Neutropenia / Q000188:drug therapy* / Q000628:therapy; D018709:Statistics, Nonparametric; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D002939:Ciprofloxacin; D009355:Neomycin; D003091:Colistin