Document Detail


Prophylactic antibiotics for the prevention of neutropenic fever in patients undergoing autologous stem-cell transplantation: results of a single institution, randomized phase 2 trial.
MedLine Citation:
PMID:  20882526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
One hundred and fifty-seven patients undergoing high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) for hematopoietic malignancies and solid tumors were randomly assigned to receive (Group A) or not (Group B) prophylaxis with ciprofloxacin, orally, and vancomycin, intravenously. Prophylactic antibiotics were given from day 0 until resolution of neutropenia or the appearance of a febrile event. Furthermore, patients in both groups received once a day fluconazole, orally. The primary end-point of our study was the incidence of neutropenic febrile episodes attributed to infection. One hundred and twelve (71.3%) patients developed neutropenic fever, 50 (56.2%) in Group A and 62 (91.2%) in Group B (P < 0.001) with the majority (82%) of patients developing fever of unknown origin. Patients on prophylactic antibiotics had a significantly lower rate of bacteremias (5.6%) than did those randomized to no prophylaxis (29.4%) (P = 0.005) and, when developing neutropenic fever, they had a lower probability of response to first-line empirical antibiotics (P = 0.025). Prophylactic administration of ciprofloxacin and vancomycin reduced the incidence of neutropenic fever in patients receiving HDT with ASCT, however, without affecting the total interval of hospitalization, time to engraftment, or all-cause mortality. Therefore, our results do not support the use of antibiotic prophylaxis for patients undergoing HDT and ASCT.
Authors:
Evangelos Eleutherakis-Papaiakovou; Evangelos Kostis; Magda Migkou; Dimitrios Christoulas; Evangelos Terpos; Maria Gavriatopoulou; Maria Roussou; Evangelos Bournakis; Efstathios Kastritis; Eleni Efstathiou; Meletios A Dimopoulos; Christos A Papadimitriou
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Publication Detail:
Type:  Clinical Trial, Phase II; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of hematology     Volume:  85     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-26     Completed Date:  2010-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  863-7     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley-Liss, Inc.
Affiliation:
Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / administration & dosage,  therapeutic use
Antibiotic Prophylaxis / methods*
Ciprofloxacin / administration & dosage
Fever / prevention & control
Graft Survival
Hematologic Neoplasms / mortality,  therapy
Hematopoietic Stem Cell Transplantation / methods*
Humans
Infection
Length of Stay
Neutropenia / pathology,  prevention & control*
Survival Rate
Transplantation, Autologous
Vancomycin / administration & dosage
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin; 85721-33-1/Ciprofloxacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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