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Clinical and microbiologic outcomes of quinolone prophylaxis in children with acute myeloid leukemia

Susanna Felsenstein1, Etan Orgel, Teresa Rushing

  • 1From the *Division of Infectious Diseases, Children's Hospital Los Angeles, University of Southern California; †Children's Center for Cancer and Blood Diseases, University of Southern California; and ‡Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, CA.

The Pediatric Infectious Disease Journal
|March 13, 2015
PubMed

Insights

Ciprofloxacin prophylaxis (CPx) did not alter overall bacteremia rates in pediatric acute myeloid leukemia (AML) patients. While reducing Gram-negative infections, CPx increased viridans streptococci bacteremia, warranting further research.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Hematology

Background:

  • Intensified pediatric acute myeloid leukemia (AML) treatment improves survival but increases infection risks.
  • Ciprofloxacin prophylaxis (CPx) was adopted for pediatric AML based on adult and transplant data.
  • The study evaluated the real-world impact of CPx in pediatric AML.

Purpose of the Study:

  • To assess the effect of ciprofloxacin prophylaxis (CPx) on infection rates and outcomes in pediatric acute myeloid leukemia (AML).
  • To compare fever, neutropenia, infection spectrum, antibiotic use, and mortality before and after CPx implementation.

Main Methods:

  • Retrospective comparison of pediatric AML patients before and after CPx implementation.
  • Analysis included chemotherapy courses, fever and neutropenia episodes, infection types, and mortality.
  • Data on antibiotic use and supportive care were also collected.

Main Results:

  • CPx did not significantly alter the incidence of febrile episodes, infectious episodes, fever duration, antibiotic treatment duration, or mortality.
  • CPx significantly decreased Gram-negative rod infections (13.4% to 4.7%) but increased viridans streptococci bacteremia (12% to 28%).
  • Overall bacteremia rates remained similar (35.9% pre-CPx vs. 31.5% post-CPx).

Conclusions:

  • Ciprofloxacin prophylaxis (CPx) did not change overall bacteremia incidence or impact fever patterns and supportive care needs in pediatric AML.
  • The findings suggest CPx did not provide the expected benefit in reducing overall bacteremia.
  • Further investigation into extended-spectrum quinolone prophylaxis for pediatric AML is supported.
Abstract

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