Ciprofloxacin vs. levofloxacin for prophylaxis in recipients of hematopoietic stem cell transplantation

Abstract

Background

Infection is the most common cause of morbidity and mortality in patients undergoing myleosuppressive therapy with the risk of infection being heightened during the neutropenic phase. Fluoroquinolones are most often utilized as prophylaxis, specifically levofloxacin or ciprofloxacin; however, there is increasing resistance among these agents. The objective of this study is to compare the efficacy of ciprofloxacin and levofloxacin when used prophylactically in hematopoietic stem cell transplantation patients.

Study design

A retrospective cohort study conducted at a 443-bed tertiary teaching county hospital from 1 January 2005 to 31 September 2016.

Methods

Patients aged 18–89 who were admitted and received levofloxacin or ciprofloxacin post hematopoietic stem cell transplantation were evaluated.

Results

The patient population (N = 151) was predominantly male (93 vs. 58) and the median (IQR) age was 57 (20.1) years. There were 108 patients undergoing autologous hematopoietic stem cell transplantation compared to 43 undergoing allogenic hematopoietic stem cell transplantation. Significantly fewer patients who received levofloxacin (11/43, 25.6%) developed neutropenic fever compared to patients who received ciprofloxacin (61/108, 56.5%, p = 0.0006). Also there were significantly more positive blood cultures in the ciprofloxacin group (36/108, 33.3%) compared to the levofloxacin group (4/43, 9.3%); the majority of which were Gram-positive organisms (p = 0.0025).

Conclusion

Prophylaxis with levofloxacin was associated with a lower incidence of febrile neutropenia and bacteremia when compared to ciprofloxacin in hematopoietic stem cell transplantation patients.

Keywords

Hematopoietic stem cell transplant febrile neutropenia fluoroquinolones

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References

Winston

Champlin

et al.

Infectious complications of bone marrow transplantation. Exp Hematol 1984; 12: 205–215.

Gratwohl

Brand

Frassoni

et al.

Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant 2005; 36: 757–769.

Robert Baden L, Swaminathan S, Angarone M, et al. National Comprehensive Cancer Network Guidelines Version 2. Prevention and Treatment of Cancer-Related Infections 2016.

Tomblyn

Chiller

Einsele

et al.

Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a Global Perspective Executive Committee. Biol Blood Marrow Transplant 2009; 15: 1143–1238.

Balletto

Mikulska

. Bacterial infections in hematopoietic stem cell transplant recipients. Mediterr J Hematol Infect Dis 2015; 7: e2015045–e2015045.

Busca

Cavecchia

Locatelli

et al.

Blood stream infections after allogeneic stem cell transplantation: a single-center experience with the use of levofloxacin prophylaxis. Transpl Infect Dis 2012; 14: 40–48.

Therriault

Wilson

Barreto

et al.

Characterization of bacterial infections in allogeneic hematopoietic stem cell transplant recipients who received prophylactic levofloxacin with either penicillin or doxycycline. Mayo Clin Proc 2010; 85: 711–718.

Simondsen

Reed

Mably

et al.

Retrospective analysis of fluoroquinolone prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation. J Oncol Pharm Pract 2013; 19: 291–297.

Satlin

Vardhana

Soave

et al.

Impact of prophylactic Levofloxacin on rates of bloodstream infection and fever in neutropenic patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2015; 21: 1808–1814.

10.

Kim

Goulston

Zangari

et al.

Impact of a change in antibacterial prophylaxis on bacteremia and hospitalization rates following outpatient autologous peripheral blood stem cell transplantation for multiple myeloma. Transpl Infect Dis 2014; 16: 421–429.

11.

Liu

C-Y

Lai

Y-C

Huang

L-J

et al.

Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients. Bone Marrow Transplant 2011; 46: 1231–1239.

12.

Sohn

Yoon

Kim

et al.

The role of prophylactic antimicrobials during autologous stem cell transplantation: a single-center experience. Eur J Clin Microbiol Infect Dis 2012; 31: 1653–1661.

13.

Eleutherakis-Papaiakovou

Kostis

Migkou

et al.

Prophylactic antibiotics for the prevention of neutropenic fever in patients undergoing autologous stem-cell transplantation: results of a single institution, randomized phase 2 trial. Am J Hematol 2010; 85: 863–867.

14.

Gafter-Gvili

Fraser

Paul

et al.

Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 2005; 142(12 Pt 1): 979–995.

15.

Imran

Tleyjeh

Arndt

CAS

et al.

Fluoroquinolone prophylaxis in patients with neutropenia: a meta-analysis of randomized placebo-controlled trials. Eur J Clin Microbiol Infect Dis 2008; 27: 53–63.

16.

Koya

Andersen

Fernandez

et al.

Analysis of the value of empiric vancomycin administration in febrile neutropenia occurring after autologous peripheral blood stem cell transplants. Bone Marrow Transplant 1998; 21: 923–926.

17.

Meisenberg

Gollard

Brehm

et al.

Prophylactic antibiotics eliminate bacteremia and allow safe outpatient management following high-dose chemotherapy and autologous stem cell rescue. Support Care Cancer 1996; 4: 364–369.

18.

Gilbert

Meisenberg

Vredenburgh

et al.

Sequential prophylactic oral and empiric once-daily parenteral antibiotics for neutropenia and fever after high-dose chemotherapy and autologous bone marrow support. J Clin Oncol 1994; 12: 1005–1011.

19.

Wimperis

Baglin

Marcus

et al.

An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts. Bone Marrow Transplant 1991; 8: 363–367.

20.

Warren

Wimperis

Baglin

et al.

Prevention of infection by ciprofloxacin in neutropenia. J Antimicrob Chemother 1990; 26(Suppl F): 109–123.

21.

De Pauw

Donnelly

De Witte

et al.

Options and limitations of long-term oral ciprofloxacin as antibacterial prophylaxis in allogeneic bone marrow transplant recipients. Bone Marrow Transplant 1990; 5: 179–182.

22.

Hoogkamp-Korstanje

. In-vitro activities of ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin, pefloxacin, sparfloxacin and trovafloxacin against Gram-positive and Gram-negative pathogens from respiratory tract infections. J Antimicrob Chemother 1997; 40: 427–431.

23.

Kern

Andriof

Oethinger

et al.

Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center. Antimicrob Agents Chemother 1994; 38: 681–687.

24.

Carratala

Fernandez-Sevilla

Tubau

et al.

Emergence of fluoroquinolone-resistant Escherichia coli in fecal flora of cancer patients receiving norfloxacin prophylaxis. Antimicrob Agents Chemother 1996; 40: 503–505.

25.

Avril

Hartmann

Valteau-Couanet

et al.

Antiinfective prophylaxis with ceftazidime and teicoplanin in children undergoing high-dose chemotherapy and bone marrow transplantation. Pediatr Hematol Oncol 1994; 11: 63–73.

26.

Ariffin

Navaratnam

Mohamed

et al.

Ceftazidime-resistant Klebsiella pneumoniae bloodstream infection in children with febrile neutropenia. Int J Infect Dis 2000; 4: 21–25.