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Norfloxacin prophylaxis for neutropenic patients undergoing bone marrow transplantation
F Menichetti1, R Felicini, G Bucaneve
1Istituto di Malattie Infettive, Università di Perugia, Italy.
Abstract:
To prevent bacterial infections in the neutropenic post-transplant period, norfloxacin 400mg twice daily was administered as oral prophylaxis to 44 marrow recipients isolated in laminar airflow rooms (LAFRs). Patients had a mean age of 30 years (8-50) and a male/female ratio of 29/15. The mean duration of prophylaxis was of 41 days (20-80), that of neutropenia (PMN less than 1000 x 10(6)/l) of 31 days (6-76) and that of severe neutropenia (PMN less than 100 x 10(6)/l) of 19 days (10-55). All but two patients developed one or more febrile episodes (total episodes: 71), 33 of which were documented infections. Eighteen bacteraemias occurred and all were caused by Gram-positive cocci: five by coagulase-negative staphylococci (three methicillin resistant), four by coagulase-positive (one methicillin resistant), seven by streptococci (four S. sanguis, one S. milleri, one group B, one group C), and two by enterococci. All streptococcal and enterococcal strains, but only one MR coagulase-positive staphylococcus, proved to be resistant to norfloxacin. Norfloxacin was well tolerated and no prophylactic course had to be interrupted because of side effects. In conclusion, norfloxacin adequately prevents infections caused by Gram-negative bacilli in bone marrow recipients isolated in LAFRs, but Gram-positive infections still remain a problem in these patients indicating the need for improving this prophylactic regimen.
Insights
Norfloxacin prophylaxis effectively prevented Gram-negative bacterial infections in bone marrow transplant patients. However, Gram-positive infections persisted, highlighting the need for improved prophylactic strategies in neutropenic recipients.
Area of Science:
- Infectious Diseases
- Hematology
- Pharmacology
Background:
- Bone marrow transplant recipients are susceptible to bacterial infections during neutropenia.
- Laminar airflow rooms (LAFRs) are used to isolate patients and reduce infection risk.
- Oral norfloxacin prophylaxis is a strategy to prevent infections in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of norfloxacin prophylaxis in preventing bacterial infections in neutropenic bone marrow transplant recipients.
- To assess the incidence and types of infections occurring despite norfloxacin prophylaxis.
- To determine the tolerability and side effects of norfloxacin in this patient group.
Main Methods:
- A prospective study involving 44 bone marrow recipients isolated in LAFRs.
- Oral norfloxacin 400mg twice daily was administered for prophylaxis.
- Patient data including age, duration of prophylaxis, neutropenia, and infectious episodes were recorded.
Main Results:
- Norfloxacin effectively prevented Gram-negative bacterial infections.
- Gram-positive cocci, including resistant strains of staphylococci and streptococci, caused the majority of documented infections and bacteraemias.
- Norfloxacin was well tolerated, with no treatment interruptions due to side effects.
Conclusions:
- Norfloxacin prophylaxis is effective against Gram-negative bacilli in bone marrow recipients in LAFRs.
- Gram-positive infections remain a significant challenge, necessitating the development of improved prophylactic regimens.
- Further research is needed to enhance prophylaxis against Gram-positive pathogens in immunocompromised patients.