Antibiotic prophylaxis during chemotherapy-induced neutropenia for patients with acute leukemia.
Chemotherapy-induced neutropenia places patients with acute leukemia at high risk for bacterial infections. A number of studies performed over the past 20 years have investigated the utility of prophylactic antimicrobials, including trimethoprim-sulfamethoxazole and fluoroquinolones, to prevent infection in the setting of mucositis and neutropenia. Many of these studies have found a benefit of prophylaxis in terms of the incidence of fever and bacterial infection. Clinical guidelines do not recommend antibacterial prophylaxis, however, in part because of increasing reports of infections due to resistant organisms, including fluoroquinolone-resistant Escherichia coli, fluoroquinolone-insensitive viridans streptococci, and Clostridium difficile. To effectively use prophylaxis and simultaneously limit emerging antibiotic resistance, only patients at high risk for bacterial infections should receive prophylaxis.
Hammond
Sarah P
SP
Division of Infectious Diseases, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBBA-4, Boston, MA 02115, USA. shammond2@partners.org
Baden
Lindsey R
LR
D000208:Acute Disease; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000075202:Contraindications; D004198:Disease Susceptibility; D004311:Double-Blind Method; D024901:Drug Resistance, Multiple, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D019564:Unnecessary Procedures
D000970:Antineoplastic Agents