title: Ciprofloxacin prophylaxis delays initiation of broad-spectrum antibiotic therapy and reduces the overall use of antimicrobial agents during induction therapy for acute leukaemia: A single-centre study.
abstract: BACKGROUND
  Due to an outbreak of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae, the routine use of fluoroquinolone prophylaxis was questioned. As a result, this study was conducted with the aim to evaluate the impact of ciprofloxacin-prophylaxis on the use of broad-spectrum antibioctics and anti-mycotics.
  
  
  METHODS
  A cohort of 139 consecutive patients with acute leukaemia treated with remission-inducing induction chemotherapy between 2004-2012 at the Department of Haematology in Uppsala University Hospital was analysed.
  
  
  RESULTS
  Fifty-three patients (38%) received broad-spectrum antibiotics at the initiation of chemotherapy and were not eligible for prophylaxis. Of the remaining patients, the initiation of broad-spectrum antibiotics was delayed by 3 days in those receiving ciprofloxacin prophylaxis (n = 47) compared with those receiving no prophylaxis (n = 39). The median duration of systemic antibiotic treatment was 6 days shorter in patients receiving ciprofloxacin prophylaxis (12 vs 18 days; p = 0.0005) and the cumulative (total) median days on systemic antibiotic treatment was shortened by 8 days (15 vs 23 days, p = 0.0008). Piperacillin/tazobactam (p = 0.02), carbapenems (p = 0.05) and empiric broad-spectrum antifungals (p < 0.01) were used significantly less often when ciprofloxacin prophylaxis was given.
  
  
  CONCLUSIONS
  Ciprofloxacin prophylaxis delayed empiric therapy by 3 days and reduced overall antibiotic use in this study. These benefits must be evaluated vs the risks of development of resistant bacterial strains, making fluoroquinolone prophylaxis an open question for debate.
authors.affiliation: a Department of Medical Sciences , Section of Hematology, Uppsala University , Uppsala ;
authors.forename: Helene
authors.initials: H
authors.lastname: Hallböök
authors.affiliation: b Department of Medical Sciences , Section of Infectious Diseases, Uppsala University , Uppsala.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Lidström
authors.affiliation: b Department of Medical Sciences , Section of Infectious Diseases, Uppsala University , Uppsala.
authors.forename: Karlis
authors.initials: K
authors.lastname: Pauksens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000097:blood / Q000382:microbiology / Q000517:prevention & control; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D015780:Carbapenems / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use*; D015331:Cohort Studies; D064147:Febrile Neutropenia / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002939:Ciprofloxacin
keywords: Fluoroquinolone; acute leukaemia; ciprofloxacin; febrile neutropenia; prophylaxis