Researchers from St. Jude Children’s Research Hospital have reported that children with acute myeloid leukemia (AML) benefit from intravenous antibiotic prophylaxis during remission induction therapy. The details of this study appeared in an early online publication on May 5, 2008 in Cancer.¹

Prophylactic systemic antibiotics are often administered during periods of neutropenia associated with remission induction or consolidation for patients with AML. However, there is concern about the development of resistant organisms with the widespread use of broad-spectrum antibiotics. Although frequently utilized, documentation of effectiveness of prophylactic antibiotics in preventing sepsis in neutropenic patients is scarce in the literature.

These researchers determined the incidence of septicemia in 78 pediatric patients with AML treated between 2002 and 2007. All 78 patients received voriconazole for fungal prophylaxis. Patients were sequentially treated with no antibiotic prophylaxis, prophylaxis with an oral cephalosporin, prophylaxis with intravenous cefepime, or a combination of vancomycin and oral ciprofloxacin or a cephalosporin.

These researchers reported that:

• Oral cephalosporin alone did not reduce the incidence of bacterial sepsis or streptococcal (S) viridans sepsis compared with no prophylaxis. Cephalosporin did not decrease hospitalization time.
• Intravenous cefepime completely prevented S viridans sepsis and reduced the incidence of bacterial sepsis by 91%, with two patients developing resistant gram negative infection. This regimen decreased hospitalization by 4.1 days compared with no prophylaxis.
• Vancomycin with oral ciprofloxacin or a cephalosporin reduced bacterial sepsis by 93% and S viridans by 89% compared with no prophylaxis. This regimen decreased hospitalization by 5.7 days compared with no prophylaxis.
• Antibiotic prophylaxis did not influence the incidence of fungal infections.
• Cefepime or vancomycin prophylaxis was associated with a 20% reduction in healthcare charges.

These researchers concluded that “prophylaxis with intravenous cefepime or a vancomycin regimen and voriconazole reduced morbidity in children with AML and resulted in dramatic decreases in the incidence of septicemia and hospitalization days.”

Comments: These results suggest a practical way of preventing bacterial sepsis in children with AML.

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Reference:

¹ Kurt B, Flynn P, Shenep JL, et al. Prophylactic antibiotics reduce morbidity due to septicemia during intensive treatment for pediatric acute myeloid leukemia. Cancer [early online publication]. May 5, 2008.