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A pilot study of prophylactic ciprofloxacin during delayed intensification in children with acute lymphoblastic
Abdelmottaleb A Yousef1, Christopher J H Fryer, Fares D Chedid
1Princess Noorah Oncology Center, King Abdullaziz Medical City, Jeddah, Kingdom of Saudi Arabia.
Insights
Prophylactic ciprofloxacin significantly reduced hospitalization rates and duration in children with acute lymphoblastic leukemia (ALL) undergoing delayed intensification. This antibiotic strategy also lowered bacteremia episodes, particularly Gram-negative infections, improving patient outcomes.
Area of Science:
- Pediatric Oncology
- Infectious Disease Management
- Hematology
Background:
- Children with acute lymphoblastic leukemia (ALL) undergoing delayed intensification (DI) often experience fever and bacteremia during neutropenia.
- Hospitalization rates and duration are significant burdens in ALL treatment protocols.
Purpose of the Study:
- To evaluate the efficacy of prophylactic ciprofloxacin in reducing fever, bacteremia, and hospitalization in pediatric ALL patients post-DI.
- To assess the impact of antibiotic prophylaxis on infection rates and healthcare resource utilization.
Main Methods:
- A cohort of pediatric ALL patients received prophylactic ciprofloxacin following DI courses.
- Infection rates, hospitalization data, and intensive care unit admissions were compared to historical controls who did not receive prophylactic antibiotics.
Main Results:
- The study group receiving prophylactic ciprofloxacin showed a significant reduction in hospitalization rates (58% vs 90%) and median hospital stay (6.0 vs 10.1 days).
- Intensive care unit admissions decreased from 12% to 1.5%.
- Proven bacteremia rates were reduced from 22% to 9%, with no Gram-negative bacteremias observed in the study group.
Conclusions:
- Prophylactic ciprofloxacin administration following DI in pediatric ALL patients effectively reduces hospitalization rates and duration.
- This strategy significantly decreases the incidence of bacteremia, especially Gram-negative infections, leading to improved clinical outcomes.
Background:
We hypothesized that prophylactic administration of an appropriate antibiotic following each delayed intensification (DI) in children with acute lymphoblastic leukemia (ALL) would reduce the episodes of fever and bacteremia associated with neutropenia, and hence reduce both the rate and duration of hospitalization.
Procedure:
All patients in the study were treated according to a modified Medical Research Council United Kingdom ALL XI (MRC UKALL XI) protocol utilizing three DI courses. Between June and December 2000 patients received prophylactic ciprofloxacin following DI courses. The rates of hospitalization and bacteremias were compared to ALL patients who had received between one and three DI courses prior to June 2000.
Results:
There were 69 patients who received a total of 194 DIs (controls 130; study group 64). The rate of hospitalization was 90% in the controls and 58% in the study group (P < 0.001). The median hospital stay was 10.1 days for controls and 6.0 for the study group (P < 0.001). Intensive care unit admissions were reduced from 12 to 1.5% (P = 0.02). The overall rate of proven bacteremia was reduced from 22 to 9% (P = 0.028). There were no Gram-negative bacteremias in the study group compared to 10 (7.7%) in the controls (P < 0.001).
Conclusions:
Compared to historical controls, patients in this study receiving prophylactic ciprofloxacin had a reduced rate and duration of hospitalization and incidence of Gram-negative bacteremia.
