Prophylactic non-absorbable antibiotics in leukaemic patients

Area of Science:

• Oncology
• Infectious Diseases
• Microbiology

Background:

• Neutropenic patients undergoing cytotoxic therapy are at high risk of infection.
• Prophylactic antibiotics and isolation are used to prevent infections in these vulnerable patients.

Observation:

• A regimen of oral non-absorbable antibiotics (kanamycin-vancomycin-nystatin) was administered to nine severely neutropenic leukemia patients.
• Isolation procedures were employed concurrently with the antibiotic prophylaxis.
• Faecal organisms, particularly anaerobes, showed a significant reduction within 48 hours of initiating the antibiotic course.

Findings:

• Most bacteria were eliminated from stool samples within five days of antibiotic administration.
• Three episodes of bloodstream infections occurred, all caused by enteric organisms.
• One of these infections proved fatal.
• A major challenge identified was the emergence of aminoglycoside resistance in fecal flora, notably Klebsiella, observed in 6 out of 11 treatment courses.

Implications:

• While effective in reducing gut flora, the prophylactic use of kanamycin-vancomycin-nystatin is complicated by the development of antibiotic resistance.
• This resistance, particularly to aminoglycosides, can compromise the effectiveness of prophylaxis and poses a risk for subsequent infections.
• Alternative strategies or careful monitoring for resistance are crucial for managing infections in neutropenic patients.