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Prophylactic antibiotics for the prevention of early infection in multiple myeloma
M M Oken1, C Pomeroy, D Weisdorf
1Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.
Purpose:
Patients with multiple myeloma are at increased risk for bacterial infection. During the first 2 months of initial chemotherapy the rate of infection is twice that experienced during the remainder of the disease course. As many as one-third of these early infections are fatal, and many more prevent adequate administration of chemotherapy. This study was designed to determine whether the morbidity and mortality of early infection can be prevented by prophylactic administration of trimethoprim-sulfamethoxazole (TMP-SMX).
Patients And Methods:
Eligible patients about to begin chemotherapy for multiple myeloma were randomly assigned to prophylaxis for 2 months or to no prophylaxis (control). Antibiotic prophylaxis consisted of TMP-SMX 160/800 mg orally every 12 hours administered for the first 2 months of initial chemotherapy. All patients were observed for infection for 3 months after the start of chemotherapy.
Results:
Of 57 patients entered into the study, 54 were evaluable, representing 13.1 patient-years of observation. The 28 TMP-SMX patients and 26 control patients were comparable in terms of chemotherapy regimen, age, gender, stage, and bone marrow function. Bacterial infection during the 3-month study period occurred in 11 control patients but in only 2 patients assigned TMP-SMX (P = 0.004). Eight severe infections occurred in controls compared with 1 in a TMP-SMX patient (P = 0.010) leading to 4 and 1 infection deaths, respectively (P = not significant). Severe infections included 5 pneumonias (3 with sepsis), 2 urinary tract infections with complicating pneumonia or sepsis, 1 diverticulitis with perforation, and 1 staphylococcal scalded skin syndrome. None of the 4 nonbacterial infections was severe. The rate of bacterial infection was 2.43 per patient-year for controls and 0.29 per patient-year for the TMP-SMX group (P = 0.001). Toxicity (skin rash 6 patients, nausea 1 patient) was not life-threatening but required discontinuation of TMP-SMX in 25% of patients.
Conclusion:
Administering TMP-SMX for the first 2 months of initial chemotherapy is effective, inexpensive prophylaxis for early bacterial infection in multiple myeloma.
Insights
Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) significantly reduces early bacterial infections in multiple myeloma patients undergoing chemotherapy. This inexpensive treatment lowers infection rates and severity during the critical initial treatment phase.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Patients with multiple myeloma face a heightened risk of bacterial infections, particularly during the initial two months of chemotherapy.
- These early infections can be severe, with up to one-third proving fatal, and often impede the administration of necessary chemotherapy.
- The need for effective preventive strategies against early-onset infections in multiple myeloma patients is critical.
Purpose of the Study:
- To evaluate the efficacy of prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) in preventing early bacterial infections in multiple myeloma patients.
- To determine if TMP-SMX prophylaxis can reduce the morbidity and mortality associated with infections during the initial chemotherapy period.
Main Methods:
- A randomized controlled trial was conducted with eligible multiple myeloma patients commencing chemotherapy.
- Patients were assigned to receive either TMP-SMX prophylaxis (160/800 mg orally every 12 hours for 2 months) or no prophylaxis (control group).
- Infection surveillance was maintained for all participants for three months post-chemotherapy initiation.
Main Results:
- Bacterial infections occurred in significantly fewer patients receiving TMP-SMX (2/28) compared to the control group (11/26) (P = 0.004).
- Severe infections were also less frequent in the TMP-SMX group (1 vs. 8 in controls, P = 0.010), with a trend towards fewer infection-related deaths.
- The rate of bacterial infection per patient-year was substantially lower in the TMP-SMX group (0.29) versus the control group (2.43) (P = 0.001).
Conclusions:
- Prophylactic administration of trimethoprim-sulfamethoxazole (TMP-SMX) is an effective strategy for preventing early bacterial infections in multiple myeloma patients.
- TMP-SMX prophylaxis is an inexpensive and beneficial intervention for reducing infection-related complications during the initial phase of chemotherapy.
- While generally well-tolerated, TMP-SMX discontinuation due to toxicity (e.g., rash) occurred in 25% of patients.