Selective bowel decontamination for the prevention of infection in acute myelogenous leukemia: A prospective randomized trial.
- Author:
Dong Gun LEE
1
;
Jung Min YOON
;
Jae Hyoung CHO
;
Su Mi CHOI
;
Yoon Hee PARK
;
Yoo Jin KIM
;
Seok LEE
;
Jung Hyun CHOI
;
Jong Wook LEE
;
Wan Shik SHIN
;
Chun Choo KIM
Author Information
1. Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Decontamination;
Leukemia;
Myelocytic;
Acute
- MeSH:
Adult;
Anemia, Aplastic;
Bone Marrow Transplantation;
Ciprofloxacin;
Decontamination*;
Drug Therapy;
Erythromycin;
Fever;
Fluconazole;
Hematologic Neoplasms;
Hospitalization;
Humans;
Incidence;
Leukemia;
Leukemia, Myeloid, Acute*;
Leukocyte Count;
Mortality;
Neutropenia;
Prospective Studies*;
Roxithromycin
- From:Korean Journal of Medicine
2001;60(2):167-174
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Infections are still a frequent cause of morbidity and mortality in patients with hematologic malignancies. Antimicrobial prophylaxis in neutropenic patients has been practised for several decades. But, recently the rates of occurrence for pathogens have significantly changed (from predominance of gram-negative to gram-positive species) under selective pressure of antimicrobial prophylaxis, and novel resistance mechanisms have emerged. We investigated this study to assess the effectiveness of selective bowel decontamination for preventing infections in granulocytopenic patients who are receiving chemotherapy for acute myelogenous leukemia. METHODS: In a prospective, randomized trial, we evaluated the efficacy of oral ciprofloxacin (250 mg p.o. twice a day), roxithromycin (150 mg p.o. twice a day), fluconazole (50 mg p.o.) in 95 adult patients with acute myelogenous leukemia who undergone intensive chemotherapy. Prophylaxis was begun within 72 hours of initiation of the chemotherapy and continued until the onset of fever, signs or symptoms of infection, serious adverse effect, or recovery of the leukocyte count to > or = 1,000/mm3. RESULTS: 46 decontamination regimen treated patients and 49 control patients were assessable for efficacy. No difference was noted between the two groups in occurrence of fever during neutropenia, time to onset of first fever, sites of infection, duration of using systemic antimicrobials, overall infection rates, infection-related mortality, or hospitalization day. Decontamination regimen reduced the gram-negative infections, but increased the gram-positive infections. Among those who received decontamination regimen, the incidence of resistance to ciprofloxacin was 100% for gram-negative species. And resistance to erythromycin for gram-positive species, irrespective of decontamination, was very much high (90-100%). CONCLUSION: The approach of selective decontamination has not led to fewer febrile episodes or to a lower mortality in neutropenia after chemotherapy for acute myelogenous leukemia. It should be considered that we had better not prescribe decontamination regimen because of increment of infection due to gram-positive species and high resistance rate to fluoroquinolone and macrolide. Additional trials are needed to establish the efficacy of decontamination for other malignancies, aplastic anemia, or bone marrow transplantation.
