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[Preventive systemic antibiotherapy with ceftriaxone alone in neutropenic patients treated in a protected
J L Harousseau1, N Milpied, A E Reynaud
1Service d'Hématologie clinique, CHR de Nantes.
Abstract:
Prophylactic systemic antibiotic therapy with ceftriaxone alone was tested in aplastic patients receiving total gut decontamination and treated in a protected environment. Only patients who were afebrile when their polymorphonuclear (PMN) count fell below 500/cumm were admitted to the study. Seventy-eight episodes of therapeutic aplasia (consecutive to allogeneic or autologous bone marrow transplant conditioning regimens or to high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 days (range 11-93 days). Twenty patients received, during 22 episodes of aplasia, one single injection of ceftriaxone per day as soon as their PMN count was below 500/mm3. In 13 cases (59%) the patients remained afebrile until the end of aplasia, and no bacteriemia was detected. The second part of the study was randomized between group A (prophylactic ceftriaxone: 29 cases) and group B (no prophylactic ceftriaxone: 27 cases). Patients in group A had significantly more episodes of afebrile aplasia (34.5% vs 4%) and less bacteriemias (10% vs 48%) than those in group B. Also fever developed later in group A (mean: 12.5 vs 6 days). No death was recorded throughout the study. Thus, in a protected environment prophylactic systemic antibiotic therapy could still lessen the risk of bacterial infection. Using one single antibiotic seemed to reduce the side-effects and cost of the prophylactic treatment.
Insights
Prophylactic systemic antibiotic therapy using ceftriaxone in patients with aplasia significantly reduced fever and bacteremia. This approach, within a protected environment, offers a cost-effective strategy to prevent bacterial infections during neutropenia.
Area of Science:
- Infectious Diseases
- Hematology
- Pharmacology
Background:
- Patients undergoing bone marrow transplant conditioning or high-dose chemotherapy often experience therapeutic aplasia.
- Aplastic phases are characterized by a critically low polymorphonuclear (PMN) count, increasing susceptibility to infections.
- Total gut decontamination and protected environments are standard supportive care measures.
Purpose of the Study:
- To evaluate the efficacy of prophylactic systemic antibiotic therapy with ceftriaxone in preventing bacterial infections during aplasia.
- To compare outcomes between patients receiving prophylactic ceftriaxone and those who did not.
Main Methods:
- A study involving 78 episodes of therapeutic aplasia in patients with PMN counts below 500/mm³.
- An initial phase tested daily ceftriaxone injections in 22 episodes.
- A randomized controlled trial compared prophylactic ceftriaxone (Group A, 29 cases) versus no prophylaxis (Group B, 27 cases).
Main Results:
- In the initial phase, 59% of patients receiving ceftriaxone remained afebrile with no detected bacteremia.
- The randomized phase showed significantly more afebrile aplasia episodes (34.5% vs 4%) and fewer bacteremias (10% vs 48%) in Group A.
- Fever onset was delayed in Group A (mean 12.5 days) compared to Group B (mean 6 days).
Conclusions:
- Prophylactic systemic antibiotic therapy with ceftriaxone can significantly reduce the risk of bacterial infections in aplastic patients within a protected environment.
- A single-agent prophylactic antibiotic regimen appears to minimize side effects and reduce costs.
- This strategy is effective in preventing febrile episodes and bacteremia during periods of severe neutropenia.