Prevention of infections in granulocytopenic patients by fluorinated quinolones

Despite the dramatic decline in the infection-associated death rate as a result of advances in antimicrobial therapy, extensive diagnostic procedures, and better supportive care, morbidity from infectious disease in granulocytopenic patients remains a problem. Several approaches are used for infection prevention. The new oral fluorinated quinolones seem promising for the prevention of infections caused by gram-negative bacilli. Results from different studies showed that these compounds are more efficacious and better tolerated than are other prophylactic regimens. Prophylactic use of quinolones leads to trends in bacteriologically documented infections toward gram-positive microorganisms associated either with the presence of central intravenous catheters (Staphylococcus epidermidis) or with chemotherapy-induced mucositis (alpha-hemolytic streptococci). These changes suggest a need for the inclusion of an antibiotic effective against gram-positive organisms in the initial therapeutic regimen.