Prevention of infections in neutropenic patients with pefloxacin.

Bacterial infections remain a major source of morbidity and mortality in neutropenic patients. Therefore, optimal methods of prevention seem mandatory and various means have been tested, in particular specific modalities such as chemoprophylaxis, which remains controversial. Overall, non-absorbable antibiotics have been disappointing and are less commonly used because of the poor compliance of most patients. Co-trimoxazole has been shown to be effective under certain circumstances but the emergence of resistance, and the risk of prolonging the duration of neutropenia are major drawbacks despite the advantages of co-trimoxazole being well tolerated and effective in preventing Pneumocystis carinii infections. Recently, fluoroquinolones have been developed and numerous studies of prophylaxis have been performed with norfloxacin, enoxacin, ciprofloxacin, and other agents from this class, including pefloxacin. These data show a significant reduction of bacteraemia caused by Gram-negative bacilli in neutropenic patients but a high incidence of infection caused by Gram-positive cocci, mainly streptococci. The sources of those infections are many including mucositis due to chemotherapy and/or total body irradiation, as well as changes in the patient's flora due to more effective cover against Gram-negative bacilli. Future studies should further investigate regimens to achieve optimal prophylaxis for infections caused by either Gram-negative or Gram-positive pathogens during neutropenia.