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Prophylactic co-trimoxazole versus norfloxacin in neutropenic children--perspective randomized study
M Cruciani1, E Concia, A Navarra
1Institute of Infectious Diseases, Ospedale Civile Maggiore, Verona.
Insights
Norfloxacin and co-trimoxazole were compared for preventing bacterial infections in children with cancer. Norfloxacin showed better eradication of gram-negative bacteria and did not increase resistance, unlike co-trimoxazole.
Area of Science:
- Pediatric Oncology
- Infectious Disease Prevention
- Pharmacology
Background:
- Granulocytopenic children with malignancies are at high risk for bacterial infections.
- Prophylactic antibiotics are crucial for managing infections in immunocompromised pediatric patients.
- Evaluating the efficacy and resistance patterns of antibiotics like co-trimoxazole and norfloxacin is essential.
Purpose of the Study:
- To compare the effectiveness of co-trimoxazole and norfloxacin in preventing bacterial infections in granulocytopenic children with malignancies.
- To assess the impact of each antibiotic on the development of antimicrobial resistance in gut flora.
- To evaluate clinical outcomes such as febrile episodes and documented infections.
Main Methods:
- A randomized study involving 44 granulocytopenic children with malignancies.
- Administration of either co-trimoxazole or norfloxacin for bacterial infection prophylaxis.
- Monitoring of febrile episodes, microbiologically documented infections, and stool cultures for resistance.
Main Results:
- While co-trimoxazole group had more febrile episodes, mean febrile days and systemic antibiotic use did not differ significantly.
- Co-trimoxazole prophylaxis significantly increased resistance to gram-negative bacilli in stool cultures (p < 0.001).
- Norfloxacin did not select for resistant strains and effectively eradicated gram-negative bacilli from stools (27.5% positive cultures).
Conclusions:
- Norfloxacin demonstrated superior activity in eradicating gram-negative bacilli and preventing resistance compared to co-trimoxazole.
- Co-trimoxazole prophylaxis led to a significant increase in resistant gram-negative bacilli.
- Norfloxacin appears to be a safer prophylactic option regarding antimicrobial resistance development in this patient population.
Abstract:
Co-trimoxazole or norfloxacin were randomly administered to 44 granulocytopenic children with malignancies in order to prevent bacterial infections. Although more patients in the co-trimoxazole group had febrile episodes (p less than 0.01), the mean of febrile days and the mean of days with systemic antibiotics did not differ significantly in the two groups. Five patients in the co-trimoxazole group had a microbiologically documented infection (four with septicemia) due to Escherichia coli (n = 2), Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus sp. There were four septicemic episodes in the norfloxacin group due to P. aeruginosa, Streptococcus pneumoniae, Streptococcus mitis and Streptococcus faecalis. Compliance was good during administration of both drugs. No signs or symptoms of arthropathy were seen in the norfloxacin group. The number of gram-negative bacilli resistant to co-trimoxazole isolated from stools significantly increased during prophylaxis with co-trimoxazole (p less than 0.001). Norfloxacin did not select resistant strains and was very active in eradicating gram-negative bacilli from stools (27.5% of positive cultures).