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Antibacterial prophylaxis with trimethoprim-sulfamethoxazole during induction treatment for acute lymphoblastic
H Schrøder1, K E Agger, S Rosthøj
1Department of Pediatrics, University Hospital of Aarhus.
Insights
Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis during induction therapy for childhood acute lymphoblastic leukemia (ALL) significantly reduced febrile episodes and bacteremia. This suggests TMP-SMX is effective in preventing infections in immunocompromised children undergoing ALL treatment.
Area of Science:
- Pediatric Oncology
- Infectious Disease Prevention
- Hematology
Background:
- Children with acute lymphoblastic leukemia (ALL) experience profound immunosuppression due to intensive chemotherapy.
- Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is used in some centers to prevent bacterial and Pneumocystis carinii infections.
- The use of TMP-SMX prophylaxis during induction therapy varied across Danish pediatric oncology departments.
Purpose of the Study:
- To evaluate the effect of TMP-SMX prophylaxis on bacterial infections in children with ALL during induction therapy.
- To compare the incidence of fever, febrile days, antibiotic treatment, and positive blood cultures between children receiving and not receiving TMP-SMX prophylaxis.
Main Methods:
- Retrospective review of medical charts for 210 children diagnosed with ALL between 1992 and 1997.
- Data collected included fever episodes, febrile days, antibiotic treatment duration, and positive blood cultures for each febrile episode.
- Children were categorized into groups based on whether they received TMP-SMX prophylaxis during induction therapy.
Main Results:
- Children receiving TMP-SMX prophylaxis had significantly fewer episodes of fever (58% vs. 79%, p <0.01).
- Fewer children on TMP-SMX prophylaxis had positive blood cultures before antibiotic treatment (20% vs. 49%, p<0.001).
- Nineteen bacterial species were isolated; common pathogens in the non-prophylaxis group included Staph. aureus, Str. pneumoniae, E. coli, and P. aeruginosa. No significant difference in mortality was observed (p=0.44).
Conclusions:
- TMP-SMX prophylaxis during induction therapy for childhood ALL appears to reduce the risk of bacteremia and febrile illness.
- The findings support the use of TMP-SMX for infection prophylaxis in immunocompromised pediatric ALL patients.
- No cases of Pneumocystis carinii pneumonia were reported during the induction therapy period in this study.
Background And Purpose:
Children with acute lymphoblastic leukemia are treated with intensive chemotherapy resulting in profound immuno suppression. Therefore treatment with trimethoprim-sulfamethoxazole (TMP-SMX) may be used for prophylaxis against infections both with bacteria and Pneumocystis carinii in some departments. The use of TMP-SMX for prophylaxis during the induction therapy is not uniform in the four departments of pediatric oncology in Denmark. This gave us the opportunity to describe the effect of TMP/SMX on bacterial infections in children with ALL during the induction therapy.
Material And Methods:
Between January 1st 1992 and December 31st 1997, 210 children were diagnosed with ALL in Denmark. Based on a retrospective review of the medical charts the number of children with fever (>38 degrees C), the number of febrile days, days of antibiotic treatment and the number of positive blood cultures were registered for every febrile episode.
Results:
One hundred and fourteen children received TMP/SMX prophylaxis (10-30 mg/SMX/kg/day) and 76 did not. Children who received TMP/SMX prophylaxis had significantly fewer episodes of fever (66/114 (58%) v 60/76 (79%), p <0,01), and significantly fewer children who received TMP/SMX prophylaxis had positive blood cultures before start of antibiotic treatment compared with children who did not receive prophylaxis (23/114 (20%) vs 37/76 (49%), p<0.001)). Nineteen different species were isolated from the blood stream before start of antibiotic treatment. In the non-prophylaxis group there was a preponderance of isolates with Staph. aureus, Str. pneumoniae, E. coli and P. aeruginosa. There was no difference in the mortality between the two groups (p=0.44). There were no cases of P carinii pneumonia in the period of induction therapy.
Conclusion:
TMP/SMX prophylaxis during induction therapy for childhood ALL seems to reduce the risk of bacteremias and febrile illness.