Cefpodoxime for antimicrobial prophylaxis in neutropenia: a retrospective case series.
BACKGROUND
Antimicrobial prophylaxis in select neutropenic patients has reduced fever, infection rates, hospital length of stay, and hospitalization rates. Guidelines from the Infectious Diseases Society of America recommend the consideration of prophylaxis with a fluoroquinolone in patients at high risk for infection after chemotherapy. The use of fluoroquinolones has been associated with many adverse events, and there is limited evidence on alternative antimicrobial prophylaxis in patients intolerant of fluoroquinolones.


OBJECTIVE
Our study describes a single-center experience of cefpodoxime as an alternative to fluoroquinolones for antibacterial prophylaxis during neutropenia after chemotherapy and represents a retrospective evaluation of an oral cephalosporin in adult patients for this purpose.


METHODS
This retrospective case series analyzed data from the electronic medical records of 41 patients having hematologic malignancies and given cefpodoxime for neutropenic prophylaxis.


RESULTS
The rate of febrile neutropenia was 85%, with 60% culture-positive infections. Gram-positive organisms were identified in 52% of positive cultures, and gram-negative organisms represented 40% of positive cultures. Antimicrobial resistance to guideline-recommended empiric treatment regimens was not seen in breakthrough infections.


CONCLUSIONS
Cefpodoxime can be utilized for prophylaxis, without adversely affecting resistance to broad-spectrum agents, and maintains a high level of appropriateness of guideline-recommended empiric regimens. This study of cefpodoxime prophylaxis in adult patients intolerant to fluoroquinolones adds to the literature of potential alternative agents for prophylaxis in neutropenic patients.
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Daniel J
DJ
Wojenski
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota. Electronic address: barreto.jason@mayo.edu.
Jason N
JN
Barreto
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Robert C
RC
Wolf
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
Pritish K
PK
Tosh
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D015296:Ceftizoxime / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy; D024841:Fluoroquinolones; D019337:Hematologic Neoplasms; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult; D000097623:Cefpodoxime
D000900:Anti-Bacterial Agents; D015296:Ceftizoxime; D002511:Cephalosporins; D024841:Fluoroquinolones; D000097623:Cefpodoxime
antibiotic prophylaxis; bacterial infections/prevention and control; cephalosporin; neoplasms/drug therapy; neutropenia