INTRODUCTION: The efficacy and safety of oral ofloxacin were compared with those of vancomycin/polymyxin for prophylaxis of bacterial infections in granulocytopenic patients undergoing chemotherapy for hematologic malignancy. PATIENTS AND METHODS: Antimicrobial prophylaxis was begun at the time of initiation of chemotherapy. Thirty patients received ofloxacin tablets (300 mg orally every 12 hours) plus a nystatin suspension. Thirty-two patients received vancomycin capsules (500 mg orally every eight hours) and polymyxin capsules (100 mg orally every eight hours) plus a nystatin suspension. RESULTS: In the group of patients receiving ofloxacin, there were a lower number of acquired gram-negative bacillary organisms per patient (0.13 versus 1.37, p less than 0.00005), fewer patients with documented infection (11 of 30 versus 21 of 32, p = 0.04), and fewer cases of gram-negative septicemia (zero of 30 versus five of 32, p = 0.05). Ofloxacin was also better tolerated (24 of 30 versus 10 of 32 patients highly compliant, p = 0.01) and associated with fewer gastrointestinal side effects (one of 30 versus nine of 32 patients with gastrointestinal side effects, p = 0.01) than vancomycin/polymyxin. However, except for a reduction of Staphylococcus aureus colonization and infection by ofloxacin, neither ofloxacin nor vancomycin/polymyxin was effective in eliminating colonization or infection with viridans group streptococci, coagulase-negative staphylococci, or other gram-positive organisms. Only three isolates of ofloxacin-resistant gram-negative bacteria (Pseudomonas fluorescens, Pseudomonas putida, and Enterobacter aerogenes) were isolated from surveillance cultures, but none caused infection. CONCLUSION: These results suggest that oral ofloxacin is a more tolerable and efficacious alternative to vancomycin/polymyxin for prevention of serious gram-negative bacillary infections in granulocytopenic patients. More effective prophylaxis of gram-positive infections, however, is still needed.
RCT Entities:
INTRODUCTION: The efficacy and safety of oral ofloxacin were compared with those of vancomycin/polymyxin for prophylaxis of bacterial infections in granulocytopenicpatients undergoing chemotherapy for hematologic malignancy. PATIENTS AND METHODS: Antimicrobial prophylaxis was begun at the time of initiation of chemotherapy. Thirty patients received ofloxacin tablets (300 mg orally every 12 hours) plus a nystatin suspension. Thirty-two patients received vancomycin capsules (500 mg orally every eight hours) and polymyxin capsules (100 mg orally every eight hours) plus a nystatin suspension. RESULTS: In the group of patients receiving ofloxacin, there were a lower number of acquired gram-negative bacillary organisms per patient (0.13 versus 1.37, p less than 0.00005), fewer patients with documented infection (11 of 30 versus 21 of 32, p = 0.04), and fewer cases of gram-negative septicemia (zero of 30 versus five of 32, p = 0.05). Ofloxacin was also better tolerated (24 of 30 versus 10 of 32 patients highly compliant, p = 0.01) and associated with fewer gastrointestinal side effects (one of 30 versus nine of 32 patients with gastrointestinal side effects, p = 0.01) than vancomycin/polymyxin. However, except for a reduction of Staphylococcus aureus colonization and infection by ofloxacin, neither ofloxacin nor vancomycin/polymyxin was effective in eliminating colonization or infection with viridans group streptococci, coagulase-negative staphylococci, or other gram-positive organisms. Only three isolates of ofloxacin-resistant gram-negative bacteria (Pseudomonas fluorescens, Pseudomonas putida, and Enterobacter aerogenes) were isolated from surveillance cultures, but none caused infection. CONCLUSION: These results suggest that oral ofloxacin is a more tolerable and efficacious alternative to vancomycin/polymyxin for prevention of serious gram-negative bacillary infections in granulocytopenicpatients. More effective prophylaxis of gram-positive infections, however, is still needed.
Authors: Michele Pohlen; Julia Marx; Alexander Mellmann; Karsten Becker; Rolf M Mesters; Jan-Henrik Mikesch; Christoph Schliemann; Georg Lenz; Carsten Müller-Tidow; Thomas Büchner; Utz Krug; Matthias Stelljes; Helge Karch; Georg Peters; Hans U Gerth; Dennis Görlich; Wolfgang E Berdel Journal: Haematologica Date: 2016-07-28 Impact factor: 9.941
Authors: D D'Antonio; E Pizzigallo; A Iacone; M Dell'Isola; G Fioritoni; S Betti; A Piergallini; R Di Gianfilippo; P Olioso; G Torlontano Journal: Eur J Epidemiol Date: 1992-09 Impact factor: 8.082