Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions

Autor: Irina Rajakumar, Adrienne Fulford, Jamie A. Seabrook, Samantha S. F. Lee, Maureen Quinn
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Levofloxacin
03 medical and health sciences
0302 clinical medicine
hemic and lymphatic diseases
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Chemotherapy-Induced Febrile Neutropenia
Antibiotic prophylaxis
Intensive care medicine
Aged
Retrospective Studies
Chemotherapy
business.industry
Myeloid leukemia
Retrospective cohort study
Consolidation Chemotherapy
Antibiotic Prophylaxis
Middle Aged
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
medicine.disease
Anti-Bacterial Agents
Hospitalization
Leukemia
Myeloid
Acute
Diarrhea
Oncology
030220 oncology & carcinogenesis
Clostridium Infections
Female
medicine.symptom
business
Febrile neutropenia
030215 immunology
medicine.drug
Zdroj: Supportive Care in Cancer.
ISSN: 1433-7339
0941-4355
DOI: 10.1007/s00520-017-3976-1
Popis: The purpose of this study is to evaluate the efficacy and safety of prophylactic oral levofloxacin in acute myeloid leukemia (AML) patients after receiving consolidation chemotherapy to prevent febrile neutropenia. We conducted a retrospective chart review of 50 AML patients who were prescribed levofloxacin and 50 AML patients who were not prescribed levofloxacin post-consolidation chemotherapy between June 2006 and August 2013 at a tertiary academic medical center. The primary outcome of this study was to evaluate the effectiveness of levofloxacin in preventing hospital readmission due to febrile neutropenia. Secondary outcomes evaluated the safety of this therapy, including the rate of Clostridium difficile-associated diarrhea (CDAD) within 30 days from discharge of receiving consolidation chemotherapy and rate of fluoroquinolone resistance in positive bacterial cultures. Hospital readmission due to febrile neutropenia after the first consolidation cycle occurred in 42% of patients prescribed levofloxacin, as compared to 72% that were not prescribed levofloxacin (p = 0.002). This was also significantly reduced when levofloxacin was prescribed after all consolidation cycles (51.4 vs. 67%, p = 0.023). CDAD did not occur in any patient prescribed levofloxacin after the first cycle, compared to one case in those not prescribed levofloxacin. Evaluation of the impact on fluoroquinolone resistance was limited due to a paucity of fluoroquinolone susceptibilities reported. Prescribing oral levofloxacin post-consolidation chemotherapy in AML patients is associated with a reduction in febrile neutropenia. Further research is required to identify the impact on fluoroquinolone resistance and risk of CDAD.
Databáze: OpenAIRE
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