title: Prophylactic first-line antibiotics reduce infectious fever and shorten hospital stay during chemotherapy-induced agranulocytosis in childhood acute myeloid leukemia.
abstract: OBJECTIVE
  There exists few pediatric data on the safety and efficacy of prophylactic antibiotics during chemotherapy-induced agranulocytosis.
  
  
  METHODS
  We prospectively studied the incidence of infection-related fever in 38 children, aged 2-16 years, with acute myeloid leukemia (AML) over 121 chemotherapy treatment cycles. A prophylactic group (n = 18) was given either vancomycin/cefepime (400 mg/m(2), q12 h/50 mg/kg, q12 h) or piperacillin/tazobactam (110 mg/kg, q12 h). Control patients (n = 20) received no preventive antibiotics.
  
  
  RESULTS
  The prophylactic group (59 treatment cycles) experienced fever less frequently than the control group (0.4 vs. 0.9 events; p < 0.001), had a longer interval between agranulocytosis and fever (6.4 vs. 3.8 days; p = 0.007), had a shorter duration of hospitalization (21.5 vs. 28.5 days; p < 0.001), and had a lower rate of lung infection (38.8 vs. 80.0%; p < 0.001). One patient taking vancomycin experienced a skin rash and 3 patients taking piperacillin/tazobactam had diarrhea; these side effects subsided after antibiotics were discontinued.
  
  
  CONCLUSIONS
  In children with AML, prophylactic antibiotics during the period of chemotherapy-induced agranulocytosis can effectively reduce the incidence of infectious fever and can shorten the average length of hospital stay, improving treatment success and quality of life.
authors: Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
authors: Xiaoqin
authors: X
authors: Feng
authors: Yongsheng
authors: Y
authors: Ruan
authors: Yuelin
authors: Y
authors: He
authors: Yuming
authors: Y
authors: Zhang
authors: Xuedong
authors: X
authors: Wu
authors: Huayin
authors: H
authors: Liu
authors: Xuan
authors: X
authors: Liu
authors: Lan
authors: L
authors: He
authors: Chunfu
authors: C
authors: Li
mesh_terms: D000293:Adolescent; D000380:Agranulocytosis / Q000139:chemically induced* / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D000077723:Cefepime; D010397:Penicillanic Acid; D010878:Piperacillin