Fluoroquinolone plus Trimethoprim/sulfamethoxazole versus Fluoroquinolene alone for Antibacterial Prophylaxis in Allogenetc Bone Marrow Transplant Recipients

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Klin Onkol 2000; 13(1): 17-21.

Summary: Backgrounds: Absorbable antibiotics (ATB) are used as a part of antibacterial prophylaxis in patients after bone marrow transplantation (BMT), but monotherapy with these drugs may have some disadvantages: patients on fluoroquinolones (FQ) have a higher rate of G+ infections, and G- infections are more frequent among patients treated with trimethoprim-sulfamethoxazole (TMS). Thus, it seems to be practical to use these drugs in combinations. Design and Subjects: We performed a retrospective analysis comparing the efficacy of combination TMS plus FQ against FQ alone in 70 allogeneic BMT recipients. Group A consisted of 35 patients treated with TMS (960 mg tablets twice daily) plus FQ (ofloxacin 200 mg tablets twice daily). The other 35 patients, group B, received FQ (in the same dose) alone. Both groups were comparable for median age, sexual distribution, diagnosis, number of transplanted cells and disease stages as well as for previous therapies. Methods and Results: The majority of the patients in both groups terminated prophylaxis because of fever: 23 vs 27 (65.7% vs 77.1%). Two subjects from group A (5.7% vs 0%) had their prophylaxis discontinued due to intolerance of TMS. Four patients from group A and 1 patient from group B [11.4% vs 2.86%, p<0.05)] received prophylaxis until engraftment, remained free of fever and/or infections and never required therapeutic ATB. Fever of undetermined origin was diagnosed in 5 (14.3%) vs 6 (17.1%) patients. The same number of microbiologically documented infections (1 in each group) as well as clinically documented infections (4 in each group) was diagnosed. Bacteremia was found in 12 (34.3%) in both groups, sepsis in 9 (25.7%) vs 11 (31.4%) BMT recipients. In spite of our initial hope for the opposite, the addition of TMS to FQ did little to prevent G+ infections: G+ agents were found in 10 (28.6%) vs 7 (20%) bacteremias and 8 (22.9%) vs 5 sepsis (14.3%). G- bacteria were found in 3 (8.6%) vs 5 (14.3%) bacteremias and surprisingly in only 1 septic patient from group A vs 6 patients with sepsis from group B (2.96% vs 17.1%, p<0.05). There was no difference between the two groups in the duration of therapy with broad-spectrum ATB, hospitalization, the length of neutropenia and thrombocytopenia or in the median time to the onset of fever. Conclusions: The addition of TMS to FQ appears to be an inexpensive, nontoxic, well-tolerated and effective preventive regimen able to decrease the incidence of G- sepsis. We practical suspect that a impact of this adapted combination may come in the future because the use of new drugs) in antibacterial prophylaxis in BMT recipients