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Prevention of bacteremia caused by α-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin

Roxithromycin (RU-28 965) zur Prävention der Bakteriämie durch alpha-hämolytische Streptokokken bei granulozytopenischen Patienten unter Ciprofloxacin-Prophylaxe

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Summary

We previously demonstrated that ciprofloxacin prevents infections caused by gram-negative bacilli in patients with granulocytopenia. However, in patients with intensive cytotoxic treatment leading to severe mucosal damage a high incidence of bacteremias caused by α-hemolytic streptococci was seen. In the present study 45 consecutive patients undergoing intensive cytotoxic treatment received a short course of roxithromycin (10 days) in addition to ciprofloxacin for prevention of bacteremias caused by α-hemolytic streptococci. The results of this study were compared with the results obtained in previous comparable patients receiving ciprofloxacin alone. During the days with addition of roxithromycin no infections caused by α-hemolytic streptococci occurred, while in the control group of 80 patients 16 bacteremias (20%) were seen. Although roxithromycin was shown to antagonize bactericidal action of ciprofloxacin on gram-negative bacilliin vitro, in vivo study based on serum bactericidal titers and on results of surveillance cultures showed no antagonistic interactions.

Zusammenfassung

In früheren Studien konnte die präventive Wirksamkeit von Ciprofloxacin gegen Infektionen durch gramnegative Bakterien bei granulozytopenischen Patienten belegt werden. Jedoch traten bei Patienten, die mit intensiven Zytostatikaschemata behandelt wurden, häufig Bakteriämien durch alpha-hämolytische Streptokokken auf. In der vorliegenden Studie erhielten 45 Patienten, die nacheinander eingewiesen wurden und eine hochdosierte Zytostatikatherapie durchmachten, zehn Tage lang Roxithromycin als Zusatz zu einer Prophylaxe mit Ciprofloxacin, um das Auftreten septischer Infektionen durch alpha-hämolytische Streptokokken zu verhüten. Die Ergebnisse dieser Studie wurden denjenigen einer vorausgegangenen Studie mit vergleichbaren Patienten unter Prophylaxe mit Ciprofloxacin allein gegenübergestellt. Während in der Vergleichsgruppe bei 16 von 80 Patienten Bakteriämien durch alpha-hämolytische Streptokokken aufgetreten waren, kam es bei den Patienten, die Roxithromycin erhielten, zu keiner einzigen solchen Infektion, solange dieses Antibiotikum verabreicht wurde. Im Gegensatz zuIn vitro-Beobachtungen, die darauf schließen lassen, daß Roxithromycin die bakterizide Aktivität von Ciprofloxacin gegen gramnegative Bakterien antagonisiert, waren antagonistische Interaktionen in einerIn vivo-Studie anhand der Serumbakterizidietiter und Ergebnisse von Überwachungskulturen nicht festzustellen.

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Authors and Affiliations

  1. Department of Clinical Microbiology and Laboratory of Infectious Diseases, University Hospital Utrecht, P.O. Box 85.500, NL-3508 GA, Utrecht

    Maja Rozenberg-Arska M.D., Ph. D. & J. Verhoef M.D., Ph. D.

  2. Department of Haematology, University Hospital Utrecht, P.O. Box 85.500, NL-3508 GA, Utrecht

    A. Dekker M.D., Ph. D. & L. Verdonck M.D., Ph. D.

Authors
  1. Maja Rozenberg-Arska M.D., Ph. D.
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  2. J. Verhoef M.D., Ph. D.
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  3. A. Dekker M.D., Ph. D.
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  4. L. Verdonck M.D., Ph. D.
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Rozenberg-Arska, M., Verhoef, J., Dekker, A. et al. Prevention of bacteremia caused by α-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin. Infection 17, 240–244 (1989). https://doi.org/10.1007/BF01639528

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  • DOI: https://doi.org/10.1007/BF01639528

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