Ciprofloxacin prophylaxis in patients with acute leukemia and granulocytopenia in an area with a high prevalence of ciprofloxacin-resistant Escherichia coli.
BACKGROUND
Infection remains the major cause of morbidity and mortality in patients with neutropenia, and the beneficial effects of oral prophylaxis remain controversial.


METHODS
From 1993 to December 1999, the authors analyzed the clinical and microbiologic outcomes of 144 episodes of febrile neutropenia among adult patients with acute leukemia.


RESULTS
Forty-three consecutive episodes occurred among patients who were on ciprofloxacin prophylaxis during 1993-1996 (ciprofloxacin group), and 101 subsequent episodes occurred among patients who were not exposed to ciprofloxacin prophylaxis (control group). There were no differences in clinical presentation, antibiotic treatment received for the episode, or a worse outcome between groups. The rate of bacteremia was similar (12 of 43 patients [28%] vs. 26 of 101 patients [26%], respectively). There was a trend toward a higher rate of Gram positive bacteremia in the control group (12 of 101 patients [12%] vs. 2 of 43 patients [5%]) and a higher rate of Gram negative bacteremia in the ciprofloxacin group (11 of 43 patients [26%] vs. 15 of 101 patients [15%]). Resistance to fluoroquinolones was greater in Escherichia coli blood isolates from patients in the ciprofloxacin group (7 of 8 patients vs. 2 of 9 patients; P = 0.02).


CONCLUSIONS
The current results suggest that fluoroquinolone prophylaxis for patients with febrile neutropenia may be abandoned safely in areas with a high prevalence of ciprofloxacin-resistant enterobacteria.
Gomez
Lucia
L
Infectious Disease Unit, Service of Internal Medicine, Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain. lucigomez@hotmail.com
Garau
Javier
J
Estrada
Cristina
C
Marquez
Montserrat
M
Dalmau
David
D
Xercavins
Mariona
M
Martí
Josep Maria
JM
Estany
Cristina
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000276:immunology; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*
D000890:Anti-Infective Agents; D002939:Ciprofloxacin