title: Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis.
abstract: BACKGROUND
  The purpose of the current study was to prevent bloodstream infection and invasive fungal infection (IFI) by administering prophylactic antibiotic and antifungal agents during intensive chemotherapy in patients being treated for acute leukemia.
  
  
  METHODS
  Prophylaxis treatment was administered during intensive chemotherapy in children with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) from January 1, 2010 to December 31, 2012. Oral ciprofloxacin (at a dose of 300 mg/m(2) /12 hours) was administered after chemotherapy when a patient with AML or ALL became neutropenic and > 7 days of neutropenia was expected. Voriconazole (at a dose of 4 mg/kg/12 hours) was initiated at the onset of neutropenia in patients with AML and after 7 days of neutropenia in patients with ALL. Micafungin (at a dose of 2 mg/kg/day) was substituted for voriconazole when patients with ALL received vincristine. Prophylaxis treatment was discontinued when the absolute neutrophil count recovered to > 100/μL. All episodes of bloodstream infection, IFI, febrile neutropenia, and intensive care unit stays related to severe infection occurring between January 1, 2005 and December 31, 2012 were recorded.
  
  
  RESULTS
  During the preprophylaxis period, 62 children with ALL and 24 children with AML experienced a total of 44 episodes of bloodstream infection and 22 episodes of IFI. Seven patients died of severe infection. In contrast, in the prophylaxis period, 10 episodes of bloodstream infection occurred and no IFIs were reported to occur in 51 patients with ALL and 14 patients with AML. Moreover, no patient died of severe infection. Episodes of febrile neutropenia and intensive care unit stay were significantly reduced during the prophylaxis period.
  
  
  CONCLUSIONS
  Prophylaxis with ciprofloxacin and voriconazole or micafungin was found to reduce the rates of bloodstream infection and IFI in children with acute leukemia undergoing intensive chemotherapy.
authors.affiliation: Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ting-Chi
authors.initials: TC
authors.lastname: Yeh
authors.forename: Hsi-Che
authors.initials: HC
authors.lastname: Liu
authors.forename: Jen-Yin
authors.initials: JY
authors.lastname: Hou
authors.forename: Kuan-Hao
authors.initials: KH
authors.lastname: Chen
authors.forename: Ting-Huan
authors.initials: TH
authors.lastname: Huang
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Chang
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use*; D015331:Cohort Studies; D016527:Drug Costs; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011743:Pyrimidines / Q000627:therapeutic use*; D018805:Sepsis / Q000517:prevention & control*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D002939:Ciprofloxacin; D065819:Voriconazole; D000077551:Micafungin
keywords: acute lymphoblastic leukemia; acute myeloid leukemia; ciprofloxacin; micafungin; prophylaxis; voriconazole