Prevention of infection in the neutropenic patient.

All adult patients with acute nonlymphocytic leukemia--either first diagnosed or in relapse--who were admitted to University Hospital (Utrecht) between 1 December 1978 and 1 November 1980 were randomly assigned to a control group or to a group that received trimethoprim-sulfamethoxazole (TMP-SMZ) prophylactically; those admitted between 30 November 1980 and 1 December 1981 received a regimen of TMP-SMZ plus colistin; those admitted from 1 December 1981 to 1 December 1983 were randomized to receive TMP-SMZ plus colistin or neomycin plus colistin; and those admitted after 1 December 1983 were randomized to receive either ciprofloxacin alone or TMP-SMZ plus colistin. All agents were capable of preventing infections. However, the use of TMP-SMZ alone led to an increase in the number of infections caused by multiresistant microorganisms. The combination of TMP-SMZ plus colistin was superior to that of neomycin plus colistin. The new quinolone derivative ciprofloxacin was more effective than TMP-SMZ and was well tolerated. Antimicrobial prophylaxis with agents that provide adequate levels of drug in tissue prevents infections in granulocytopenic patients and is superior to that with nonabsorbable agents.

RCT Entities:   Population Interventions Outcomes