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[Antibiotic prophylaxis and therapy of febrile aplastic children with acute leukemia]
Insights
Prophylactic antibiotics in febrile children with leukemia did not prevent infections. Initial treatment with gentamicin and cefotaxime for febrile episodes showed promise but often required additional antibiotics.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Context:
- Febrile episodes (FE) are common in children with acute leukemia undergoing chemotherapy.
- Standard prophylactic regimens including trimethoprim-sulfamethoxazole (TS) are used to prevent infections.
Purpose:
- To evaluate the efficacy of a prophylactic regimen and assess initial antibiotic therapy for febrile episodes in pediatric acute leukemia patients.
Summary:
- A prophylactic regimen of trimethoprim-sulfamethoxazole (TS), colistin sulfate, and amphotericin B did not eradicate pathogens. Sixty-three percent of febrile episodes were of unknown origin, and 40.5% of isolates were TS-resistant.
- Prospective treatment of 41 febrile episodes with gentamicin and cefotaxime resulted in fever lysis within 48 hours in 22% of cases, with 63% not requiring further antibiotics.
- Overall defervescence occurred within 5 days, and no patients were lost to infectious complications, though 48-72 hour supplementation was often needed if clinical improvement was absent.
Impact:
- Findings suggest limitations of current prophylactic strategies and highlight the need for careful monitoring and potential escalation of antibiotic therapy for febrile episodes in immunocompromised pediatric cancer patients.
- This study informs clinical decision-making regarding the management of fever in pediatric oncology, emphasizing prompt and potentially combination antibiotic approaches.
Abstract:
One hundred and twenty-one febrile episodes (FE) were studied in 58 aplastic children with acute leukemia. All patients received a prophylactic regimen of trimethoprim-sulfamethoxazole (TS) and colistin sulfate orally, and amphotericin B locally from the beginning of their antineoplastic therapy. Eighty episodes were analysed retrospectively. Forty-one episodes in 24 patients were treated prospectively with a standard regimen of gentamicin + cefotaxime. The results show that the prophylactic regimen does not eradicate potentially pathogenic organisms from the throat, urine, or stools. Sixty-three per cent of FE were of unknown origin (FUU). 40.5% of all isolated organisms were TS resistant. In the prospective group, 9 of 41 FE (22%) responded to gentamicin + cefotaxime with lysis of fever within 48 hours, and 63% required no further antibiotics. Defeverescence occurred in the whole group within 5 +/- 4 days. No patients were lost to infectious complications. The combination of gentamicin + cefotaxime as initial therapy of a febrile episode must be supplemented within 48 to 72 hours by additional antibiotics in the absence of clinical improvement.