Ciprofloxacin reduces occurrence of fever in children with acute leukemia who develop neutropenia during chemotherapy.
BACKGROUND
Fluoroquinolones reduce occurrence of fever in adult cancer patients who develop neutropenia, but there has been no randomized controlled trial in children, and there are only a few studies considering resistance in intestinal floral after ciprofloxacin has been used.


METHODS
Children younger than 18 years with acute lymphoblastic leukemia or lymphoma scheduled to undergo chemotherapy were randomized to receive oral ciprofloxacin 20mg/kg/day or placebo from the beginning of their chemotherapy. Rectal swab cultures were taken before and at 1 and/or 2 weeks after the intervention.


RESULTS
Of the total of 95 patients, 45 and 50 patients received ciprofloxacin and placebo, respectively. Of the 71 patients who developed neutropenia, the proportion of children who developed fever was significantly lower in the ciprofloxacin group than in the placebo group (17/34 [50.0%] versus 27/37 [73.0%]; absolute difference in risk, -23.0%; 95% confidence interval: -45.0% to -0.9%; P = 0.046). Ciprofloxacin significantly reduced the occurrence of febrile episodes in patients with acute lymphoblastic leukemia in the induction phase of chemotherapy, but not in patients with lymphoma or in the consolidation phase of chemotherapy. Adverse effects were not different between the groups. After intervention, the percentages of Escherichia coli and Klebsiella pneumoniae susceptible to ciprofloxacin were significantly lower in the ciprofloxacin group.


CONCLUSIONS
Ciprofloxacin can prevent fever in neutropenic patients with acute lymphoblastic leukemia during the induction phase of chemotherapy with good tolerance and no serious side effects. Due to the selective pressure of intestinal flora resistance to ciprofloxacin, the long-term effectiveness needs further investigation.
Departments of Pediatrics, Prince of Songkla University, Hat-Yai, Songkhla, Thailand. kamolwish@gmail.com
Kamolwish
K
Laoprasopwattana
Thida
T
Khwanna
Pussayaban
P
Suwankeeree
Tipwan
T
Sujjanunt
Wanutsanun
W
Tunyapanit
Sureerat
S
Chelae
D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D024881:Drug Resistance, Bacterial; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications*; D010919:Placebos / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D010919:Placebos; D002939:Ciprofloxacin