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The role of fluoroquinolones in the therapy and prophylaxis of neutropenic patients with cancer

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Fluoroquinolone Antibiotics

Part of the book series: Milestones in Drug Therapy ((MDT))

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Abstract

Patients with cancer who become severely neutropenic (<500 cells/mm3) as a result of intensive myelosuppressive chemotherapy are at high risk of developing life-threatening infections which can progress to sepsis and death in a few hours, unless they are treated presumptively at the first sign of infection. This has led to the consensus that empiric therapy, while awaiting culture results, must be initiated promptly with the first evidence of a probable infection [1, 2]. Combinations of antibiotics, preferably an antipseudomonal betalactam plus an aminoglycoside provide wide coverage, bactericidal activity, and potential synergistic effects. While combination therapy may also prevent emergence of resistance. To avoid the nephrotoxic and ototoxic potential of the aminoglycosides, antibiotic monotherapy regimens such as ceftazidime, cefepime, cefpirome, cefoperazone-sulbactam and piperacillin/tazobactam as well as imipenem and meropenem have been administered with results that appear to be equivalent [2, 3].

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References

  1. Schimpff SC (1986) Empiric antibiotic therapy for granulocytopenic cancer patients.Am J Med80(Suppl 5c): 13–20

    CAS  PubMed  Google Scholar 

  2. Giamarellou H, Antoniadou A (2001) Infectious complications of febrile neutropenia.Infect Dis Clin N Amer15: 457–482

    CAS  Google Scholar 

  3. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R Pizzo P, Rolston KVI, Shenep JL, Young LS (2002) Guidelines for the use of antimicrobial agents in neutropenic patients with cancer.CID34: 730–751

    Google Scholar 

  4. Rolston KVI, Haron E, Cunningham C, Bodey GP (1989) Intravenous ciprofloxacin for infections in cancer patients.Am J Med87(Suppl SA): 261–265

    Google Scholar 

  5. Smith GM, Leyland MJ, Farrell ID, Geddes AM (1988) A clinical, microbiological and pharmacokinetic study of ciprofloxacin plus vancomycin as initial therapy of febrile episodes in neutropenic patients.JAntimicrobial Chemother21: 647–655

    CAS  Google Scholar 

  6. Samuelsson J, Nilsson PG, Wahlin A, Lerner R, Winqvist I, Palmblad J (1992) A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients.Scan J Infect Dis24: 467–475

    CAS  Google Scholar 

  7. Antabli BA, Bross B, Siegel RS, Small CD, Tabbara IA (1999) Empiric antimicrobial therapy of febrile neutropenic patients undergoing haematopoietic stem cell transplantation.Im JAntimicrob Agents13: 127–130

    CAS  Google Scholar 

  8. Bayston KF, Want S, Cohen JA (1989) A prospective randomized comparison of ceftazidime and ciprofloxacin as initial empiric therapy in neutropenic patients with fever.Am J Med87(Suppl 5A): 269–273

    Google Scholar 

  9. Lim SH, Smith MP, Goldstone AH, Machin SJ (1990) A randomized prospective study of ceftazidime and ciprofloxacin with or without teicoplanin as an empiric antibiotic regimen for febrile neutropenic patients.Br J Haematol76(Suppl 2): 41–44

    PubMed  Google Scholar 

  10. Meunier F, Zinner SH, Gaya H, Calandra T, Viscoli C, Klastersky J, Glauser M (1991) Prospective randomized evaluation of ciprofloxacinversuspiperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors.Antimicrob Agents Chemother35: 873–878

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Johnson PRE, Liu Yin JA, Tooth JA (1992) A randomized trial of high-dose ciprofloxacinversusazlocillin and netilmicin in the empirical therapy of febrile neutropenic patients.J Antimicrob Chemother30: 203–214

    CAS  PubMed  Google Scholar 

  12. Giamarellou H, Bassaris HP, Petrikkos G, Busch W, Voulgarelis M, Antoniadou A, Grouzi E, Zoumbos N (2000) Monotherapy with intravenous followed by oral high-dose ciprofloxacinversuscombination therapy with ceftazidime plus amikacin as initial empiric therapy for granulocytopenic patients with fever.Antimicrob Agents Chemother44: 3264–3271

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Chan CC, Oppenheim BA, Anderson H, Swindell R, Scarffe JH (1989) Randomized trial comparing ciprofloxacin plus netilmicinversuspiperacillin plus netilmicin for empiric treatment of fever in neutropenic patients.Antimicrob Agents Chemother33: 87–91

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Flaherty JP, Waitley D, Edlin B, George D, Arnow P, O’Keefe P, Weinstein RA (1989) Multicentre randomized trial of ciprofloxacin plus azlocillinversusceftazidime plus amikacin for empiric treatment of febrile neutropenic patients.Am J Med87(Suppl 5A): 278–282

    Google Scholar 

  15. Philpott-Howard JN, Barker KF, Wade JJ, Kaczmarski RS, Smedley JC, Mufti GJ (1990) Randomized multicentre study of ciprofloxacin and azlocillinversusgentamicin and azlocillin in the treatment of febrile neutropenic patients.JAntimicrob Chemother26(Suppl F): 89–99

    Google Scholar 

  16. Hyatt DS, Roger TRF, McCarthy DM, Samson DS (1992) A randomized trial of ciprofloxacin plus azlocillinversusnetilmicin plus azlocillin for the empirical treatment of fever in neutropenic patients.JAntimicrob Chemother28: 324–325

    Google Scholar 

  17. Kelsey SM, Wood ME, Shaw E, Jenkins GC, Newland AC (1990) A comparative study of intravenous ciprofloxacin plus benzylpenicillinversusnetilmicin plus piperacillin for the empirical treatment of fever in the neutropenic host.J Antimicrob Chemother25: 149–157

    CAS  PubMed  Google Scholar 

  18. Kelsey SM, Weinhardt B, Collins PW, Newland AC (1992) Teicoplanin plus ciprofloxacinversusgentamicin plus piperacillin in the treatment of febrile neutropenic patients.Eur J Clin Microbiol Infect Dis 11:509–514

    CAS  PubMed  Google Scholar 

  19. Cruciani M, Rampazzo R, Malma M, Lazzarini L, Todeschini G, Messori A, Concia E (1996) Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: A meta-analysisCID23: 795–805

    CAS  Google Scholar 

  20. Engels EA, Lau J, Barza M (1998) Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis.J Clin Oncol16: 1179–1187

    CAS  PubMed  Google Scholar 

  21. Delarive P, Baumgartner JD, Glauser MP, Cometta A (2000) Evaluation de la prophylaxie antibiotique chez les patients neutropeniques avec hémopathie maligne.Schweizerische Medizinische Wochenschrift130: 1837–1844

    CAS  PubMed  Google Scholar 

  22. Kern WV, Andriof E, Oethinger M, Kern P, Hacker J, Marre R (1994) Emergence of fluoroquinolone-resistantEscherichia coliat a cancer center.Antimicrob Agents Chemother38: 681–687

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Winston DJ, Lazarus HM, Beveridge RA, Hathom JQ, Gucalp R, Ramphal R, Chow AW, Ho WG, Horn R, Feld R et al (2002) Randomized, double-blind, multicenter trial comparing clinafloxacin with imipenem as empirical monotherapy for febrile granulocytopenic patientsCID32: 381–390

    Google Scholar 

  24. Talcott JA, Siegel RD, Finberg R, Goldman L (1992) Risk assessment in cancer patients with fever and neutropenia: A prospective, two-center validation of a prediction rule.J Clin Oncol10: 316–322

    CAS  PubMed  Google Scholar 

  25. Freifeld A, Pizzo P (1997) Use of fluoroquinolones for empirical management of febrile neutropenia in pediatric cancer patients.Pediatr Infect Dis J16: 140–146

    CAS  PubMed  Google Scholar 

  26. Klastersky J, Paesmans M, Rubenstein EB, Bayer M, Elting L, Feld R, Gallagher J, Herrstedt J, Paoport B, Rolston K et al (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patientsJ Clin Oncol16: 3038–3051

    Google Scholar 

  27. Rolston KVI, Rubenstein EB, Freifeld A (1996) Early empiric antibiotic therapy for febrile neutropenia patients at low risk.Infect Dis Clin NAm10: 223–237

    CAS  Google Scholar 

  28. Malik IA, Khan WA, Aziz Z, Karim M (1994) Self-administered antibiotic therapy for chemotherapy-induced low-risk febrile neutropenia patients with non-hematologic neoplasmsCID19: 533–527

    Google Scholar 

  29. Malik IA, Khan WA, Karim M, Aziz Z, Khan MA (1995) Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: Results of a prospective randomized trial.Am J Med98: 224–231

    CAS  PubMed  Google Scholar 

  30. Aquino VM, Herrera L, Sandler ES, Buchanan GR (2000) Feasibility of oral ciprofloxacin for the outpatient management of febrile neutropenia in selected children with cancer.Cancer88: 1710–1714

    CAS  PubMed  Google Scholar 

  31. Gardembas-Pain M, Desablens B, Sensebe L, Lamy T, Ghandour C, Boasson M (1991) Home treatment of febrile neutropenia: An empirical oral antibiotic regimenAnn Oncol2: 485–487

    CAS  PubMed  Google Scholar 

  32. Mullen CA, Petropoulos D, Roberts WM, Rytting M, Zipf T, Chan KW, Culbert ST, Danielson M, Jeha SS, Kuttesch JF et al (1999) Outpatient treatment of fever and neutropenia for low risk pediatric cancer patientsCancer86: 126–134

    CAS  PubMed  Google Scholar 

  33. Minotti V, Gentile G, Bucaneve G, Joni AP, Micozzi A, Cavicchi F, Barbabietola G, Landonio G, Menichetti F, Martino Pet al (1999) Domiciliary treatment of febrile episodes in cancer patients: a prospective randomized trial comparing oralversusparenteral empirical antibiotic treatment.Support Care Cancer7: 124–139

    Google Scholar 

  34. Petrilli AS, Dantas LS, Campos MC, Tanaka C, Ginani VC, Seher A (2000) Oral ciprofloxacinversusintravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: Randomized prospective trial.Medic Pediatr Oncol34: 87–91

    CAS  Google Scholar 

  35. Paganini H, Rodriguez-Brieschske T, Zubizarreta P, Latella A, Firpo V, Casimir L, Armada A, Fernandez C, Caceres E, Debbag R (2001) Oral ciprofloxacin in the management of children with cancer with lower risk febrile neutropeniaCancer91: 1563–1567

    CAS  PubMed  Google Scholar 

  36. Rubenstein EB, Rolston KVI, Benjamin RS, Loewy J, Escalante C, Manzullo E, Hughes P, Moreland B, Fender A, Kennedy K et al (1993) Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer 71: 3640–3646

    CAS  PubMed  Google Scholar 

  37. Freifeld A, Marchigiani D, Walsh T, Chanock S, Lewis L, Hiemenz J, Hiemenz S, Hicks J, Gill V, Steinberg SM et al (1999) A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy.N Engl J Med341: 305–311

    CAS  PubMed  Google Scholar 

  38. Kern WV, Commetta A, de Bock R, Langenaeken J, Paesmans M, Gaya H for the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer (1999) Oralversusintravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy.N Engl J Med341: 312–318

    Google Scholar 

  39. Freifeld A, Pizzo P (1997) Use of fluoroquinolones for empirical management of febrile neutropenia in pediatric cancer patients.Pediatr Infect Dis16: 140–146

    CAS  Google Scholar 

  40. EORTC International Antimicrobial Therapy Project Group (1984) Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patientsJ Infect Dis150: 372–379

    Google Scholar 

  41. Carlson JW, Flower JM, Mitchell SK, Carson LF, Mayer AR, Copeland LJ (1997) Chemoprophylaxis with ciprofloxacin in ovarian cancer patients receiving paclitaxel: A randomized trial. Gynecol Oncol 65: 325–329

    CAS  PubMed  Google Scholar 

  42. Martino R, Subira M, Altés A, López R, Sureda A, Domingo-Albós A, Pericas R, Brunet S (1998) Effect of discontinuing prophylaxis with norfloxacin in patients with hematologic malignancies and severe neutropenia.Acta Haematol99: 206–211

    CAS  PubMed  Google Scholar 

  43. Karp JE, Merz WG, Hendricksen C, Laughon B, Redden T, Bamberger BJ, Bartlett JG, Saral R, Burke PJ (1987) Oral norfloxacin for prevention of Gram-negative bacterial infections in patients with acute leukemia and granulocytopenia.Ann Intern Med106: 1: 7

    Google Scholar 

  44. Talbot GH, Cassileth PA, Paradiso L, Correa-Coronas R, Bond L (1993) The enoxacin prophylaxis study group. Oral enoxacin for infection prevention in adults with acute non-lymphocytic leukemia.Antimicrob Agents Chemother37: 474–482

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Winston DJ, Winston GH, Nakao SL, Gale RR Champlin RE (1986) Norfloxacinversusvancomycin/polymyxin for prevention of infections in granulocytopenic patients.Am J Med80: 884–890

    CAS  PubMed  Google Scholar 

  46. Winston DJ, Winston GH, Bruckner DA, Gale RP, Champlin RE (1990) Ofloxacinversusvancomycin/polymyxin for prevention of infections in granulocytopenic patients.Am J Med88: 36–42

    CAS  PubMed  Google Scholar 

  47. Jansen J, Cromer M, Akard L, Back JR, Wheat J, Allen SD (1994) Infection prevention in severely myelosuppressed patients: A comparison between ciprofloxacin and a regimen of selective antibiotic modulation of the intestinal flora. AmJ Med96: 335–341

    CAS  Google Scholar 

  48. Dekker AW, Rozenberg-Arska M, Verhoef J (1987) Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin and trimethoprim-sulfamethoxazole and colistin.Ann Intern Med106: 7–12

    CAS  PubMed  Google Scholar 

  49. Donnelly JP, Maschmeyer G, Daenen S (1992) Selective oral antimicrobial prophylaxis for the prevention of infection in acute leukemia — ciprofloxacinversuscotrimoxazole plus colistin.Eur J Cancer28A: 873–878

    CAS  PubMed  Google Scholar 

  50. Lew MA, Kehoe K, Ritz J, Antman KH, Nadler L, Kalish LA, Finberg R (1995) Ciprofloxacinversustrimethoprim/sulfamethoxazole for prophylaxis of bacterial infections in bone marrow transplant recipients: a randomized, controlled trial.J Clin Oncol13: 239–250

    CAS  PubMed  Google Scholar 

  51. Bow EJ, Rayner E, Louie TJ (1988) Comparison of norfloxacin with cotrimoxazole for infection prophylaxis in acute leukemia.Am J Med84: 847–854

    CAS  PubMed  Google Scholar 

  52. Cruciani M, Concia E, Navarra A, Perversi L, Bonetti F, Arico M, Nespoli L (1989) Prophylactic cotrimoxazoleversusnorfloxacin in neutropenic children — perspective randomized study.Infection17: 65–69

    CAS  PubMed  Google Scholar 

  53. Orlandi E, Navarra A, Cruciani M, Caldera D, Morra E, Castagnola C, Concia E, Bernasconi C (1990) Norfloxacinversuscotrimoxazole for infection prophylaxis in granulocytopenic patients with acute leukemia. A prospective randomized study.Haematologica75: 296–298

    CAS  PubMed  Google Scholar 

  54. Liang RHS, Yung RWH, Chan TK, Chau PY, Lam WK, So SY, Todd D (1990) Ofloxacinversusco-trimoxazole for prevention of infection in neutropenic patients following cytotoxic chemotherapy.Antimicrob Agents Chemother34: 215–218

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Kern WV, Kurrie E (1991) Ofloxacinversustrimethoprim-sulfamethoxazole for prevention of infection in patients with acute leukemia and granulocytopenia.Infection19: 73–80

    CAS  PubMed  Google Scholar 

  56. D’Antonio D, Jacone A, Fioritoni G, Betti S, Di Girolamo A, Piccolomini R, Torluteno G (1991) Antibacterial prophylaxis in granulocytopenic patients: a randomized study of ofloxacinversusnorfloxacin.Cur Ther Res50: 304–311

    Google Scholar 

  57. The GIMEMA Infection Program (1991) Prevention of bacterial infection in neutropenic patients with hematologic malignancies.Ann Intern Med115: 7–12

    Google Scholar 

  58. Bochud PY, Eggiman P, Calandra T, Van Melle G, Saghafi L, Francioli P (1994) Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors.CID18: 25–31

    CAS  Google Scholar 

  59. Kern WV, Hay B, Kern P, Marre R, Arnold R (1994) A randomized trial of roxithromycin in patients with acute leukemia and bone marrow transplant recipients receiving fluoroquinolone prophylaxis.Antimicrob Agents Chemother38: 465–472

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Bow EJ, Mandell LA, Louie TJ, Feld R, Palmer M, Zee B, Pater J (1996) Quinolone-based antibacterial chemoprophylaxis in neutropenic patients: effect of augmented Gram-positive activity on infectious morbidity.Ann Intern Med125: 183–190

    CAS  PubMed  Google Scholar 

  61. The EORTC International Antimicrobial Therapy Cooperative Group (1994) Reduction of fever and streptococcal bacteremia in granulocytopenic patients with cancer. JAMA 272: 1183–1189

    Google Scholar 

  62. Fanci R, Leoni F, Bosi A, Guidi S, Ciotti S, Longo G, Donnini E, Rossi-Ferrini P (1993) Chemoprophylaxis of bacterial infections in granulocytopenic patients with ciprofloxacinversusciprofloxacin plus amoxicillin.J Chemother5: 119–123

    CAS  PubMed  Google Scholar 

  63. Hidalgo M, Homedo J, Lunbrecas C, Trigo JM, Gómez C, Perea S, Ruiz A, Hilt R, Cortés-Funes H (1997) Lack of ability of ciprofloxacin-rifampin prophylaxis to decrease infection related morbidity in neutropenic patients given cytotoxic therapy and peripheral blood stem cell transplants.Antimicrob Agents Chemother41: 1175–1177

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Ford CD, Reilly W, Wood J, Classen DC, Burke PJ (1998) Oral antimicrobial prophylaxis in bone marrow transplant recipients: randomized trial of ciprofloxacinversusciprofloxacin-vancomycin.Antimicrob Agents Chemother42: 1402–1405

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Gómez-Martin C, Solà C, Hornedo J, Perea S, Lumbreras C, Valenti V, Arcediano A, Rodriguez M, Salazar R, Cortés-Funes H et al (2000) Rifampin does not improve the efficacy of quinolone antibacterial prophylaxis in neutropenic cancer patients: results of a randomized clinical trial.J Clin Oncol18: 2126–2134

    PubMed  Google Scholar 

  66. Carratalá J, Fernández-Sevilla A, Tuban F, Callis M, Gudiol F (1995) Emergence of quinoloneresistantEscherichia colibacteremia in neutropenic patients with cancer who have received prophylactic norfloxacin.CID20: 557–560

    Google Scholar 

  67. Cometta A, Calandra T, Bille J, Glauser MP (1994) Escherichia coli resistant to fluoroquinolones in patients with cancer and neutropenia.N Engl J Med330: 1240–1241

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Athens University School of Medicine, 4th Department of Internal Medicine, Sismanoglio General Hospital, 1 Sismanogliou St., Maroussi, Athens, 15126, Greece

    Helen Giamarellou & Anastasia Antoniadou

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  1. Helen Giamarellou
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  2. Anastasia Antoniadou
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  1. Faculty of Medicine, The University of Manitoba, 409 Tacho Avenue, Winnipeg, Manitoba, R2H 2A6, Canada

    Allan R. Ronald

  2. Microbiology Laboratory, Mt. Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

    Donald E. Low

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Giamarellou, H., Antoniadou, A. (2003). The role of fluoroquinolones in the therapy and prophylaxis of neutropenic patients with cancer. In: Ronald, A.R., Low, D.E. (eds) Fluoroquinolone Antibiotics. Milestones in Drug Therapy. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8103-6_13

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  • DOI: https://doi.org/10.1007/978-3-0348-8103-6_13

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