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Ofloxacin for prevention of bacterial infections in granulocytopenic patients

Prophylaxe bakterieller Infektionen durch Ofloxacin bei granulozytopenischen Patienten

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Summary

We studied the potential value of oral ofloxacin (200 mg twice daily) for selective decontamination and infection prevention in 40 granulocytopenic patients with acute leukemia, blast crisis of chronic myelogenous leukemia, hairy cell leukemia or severe aplastic anemia. The quality of selective decontamination was acceptable with rapid elimination of Enterobacteriaceae from the alimentary tract, only a slight decrease in concentrations of anaerobes in faeces, and a small number of newly acquired transient (twelve isolates in seven patients) or colonizing (six strains with 28 isolates in four patients) aerobic gram-negative rods andStaphylococcus aureus (one isolate) recovered from 672 surveillance cultures from faeces, oral washings and urine. Two of three patients colonized with ofloxacin-resistantPseudomonas aeruginosa strains developed Pseudomonas infections. A total of twelve acquired infections was observed. Six were microbiologically documented infections, all caused by ofloacin-resistant bacteria (twoP. aeruginosa, twoStaphylococcus epidermidis, oneAerococcus viridans, oneMicrococcus sp.). Tolerance was acceptable with no serious side effects observed. Mean drug concentrations in serum and saliva were comparable to those determined in healthy volunteers and were found to be higher in saliva than in serum. We conclude that ofloxacin may be studied as an effective alternative to trimethoprim-sulfamethoxazole for selective decontamination and infection prevention in severely granulocytopenic patients. Careful monitoring of colonizingPseudomonas spp. with decreased ofloxacin sensitivity, however, seems necessary.

Zusammenfassung

Der Wert einer Behandlung mit Ofloxacin (2 × 200 mg täglich) für die sogenannte selektive Dekontamination und Infektionsprophylaxe bei Granulozytopenie wurde bei 40 Patienten mit akuter Leukämie, akuter Phase einer CML, Haarzell-Leukämie oder schwerer aplastischer Anämie untersucht. Es kam zu einer akzeptablen Qualität der selektiven Dekontamination mit Elimination von Enterobacteriaceae in der Darmflora und einer nur geringen Verringerung in der Anaerobier-Konzentration im Stuhl. Die Auswertung von 672 Überwachungskulturen aus Rachenspülung, Stuhl und Urin zeigte eine kleine Zahl von neu entdeckten transienten (zwölf Isolate bei sieben Patienten) oder kolonisierenden (sechs Stämme mit 28 Isolaten bei vier Patienten) aeroben gramnegativen Bakterien und vonStaphylococcus aureus (ein Isolat). Zwei von drei Patienten mit Nachweis von kolonisierenden Ofloxacin-resistentenPseudomonas aeruginosa entwickelten Pseudomonas-Infektionen. Insgesamt wurden zwölf erworbene Infektionen beobachtet, davon sechs mikrobiologisch dokumentierte Infektionen, die alle durch Ofloxacin-resistente Erreger hervorgerufen wurden (zweiP. aeruginosa, zweiStaphylococcus epidermidis, einAerococcus viridans, einMicrococcus sp.). Die Verträglichkeit der Behandlung war gut. Schwere Nebenwirkungen traten nicht auf. Die gemessenen Konzentrationen von Ofloxacin in Serum und Speichel waren vergleichbar zwischen Patienten und gesunden Kontrollen. Sie waren im Speichel höher als im Serum. Ofloxacin sollte zur Prophylaxe bakterieller Infektionen bei Granulozytopenie als eine mögliche geeignete Alternative zu Trimethoprim-Sulfamethoxazol weiter untersucht werden. Das Risiko einer Koloniserung durch Ofloxacin-resistente Pseudomonaden muß dabei beachtet werden.

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  1. Medizinische Universitätsklinik und Poliklinik, Steinhövelstraße 9, D-7900, Ulm

    W. Kern,  E. Kurrle &  E. Vanek

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  2. E. Kurrle
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Kern, W., Kurrle, E. & Vanek, E. Ofloxacin for prevention of bacterial infections in granulocytopenic patients. Infection 15, 427–432 (1987). https://doi.org/10.1007/BF01647222

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