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Moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy

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Abstract

Purpose

Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. There is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting.

Methods

A retrospective chart review was completed comparing the use of prophylactic moxifloxacin to that of levofloxacin or ciprofloxacin during periods of prolonged neutropenia. Adult patients admitted to a community teaching hospital while receiving induction or reinduction chemotherapy for acute myeloid leukemia were included.

Results

One hundred and forty-one patients were included in this study. The two groups displayed slight heterogeneity: patients receiving moxifloxacin were approximately 10 years younger (54 vs. 64 years, p = 0.01), more likely to receive granulocyte colony stimulating factor (GCSF) (45 vs. 19%, p = 0.001), and neutropenic for a longer duration (23 vs. 19 days, p = 0.009). The incidence of febrile neutropenia (76 vs. 81%, RR 0.93, 95% CI 0.78–1.11, p = 0.42) and of documented infections (27 vs. 33%, RR 0.82, 95% CI 0.49–1.36, p = 0.44) was similar between those receiving moxifloxacin and levofloxacin/ciprofloxacin, respectively. Hospital readmission for an infectious issue within 30 days of hospital discharge (9 vs. 5%, p = 0.39) was also similar between groups as was the incidence of Clostridium difficile (9 vs. 9%, p = 0.96).

Conclusions

Moxifloxacin may be an alternative to levofloxacin or ciprofloxacin in patients with a prolonged risk of febrile neutropenia requiring prophylaxis.

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Abbreviations

AML:

Acute myeloid leukemia

GCSF:

Granulocyte colony stimulating factor

C. diff :

Clostridium difficile

RCT:

Randomized controlled trial

ESBL:

Extended spectrum beta-lactamase

SP:

Standard of prophylaxis

References

  1. Freifeld AG, Bow EJ, Sepkowitz KA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Disease Society of America. Clin Infect Dis 52(4):e56–e93

    Article  PubMed  Google Scholar 

  2. O’Donnell MR, Abbound CN, Altman J et al (2012) Acute myeloid leukemia. J Natl Compr Cancer Netw 10:984–1021

    Article  Google Scholar 

  3. Drlica K, Zhao X (1997) DNA gyrase, topoisomerase IV, and the 4-quinolones. Microbiol Mol Biol Rev 61:377

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Wolfson JS, Hooper DC (1989) Fluoroquinolone antimicrobial agents. Clin Microbiol Rev 2:378

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Barman Balfour JA, Wiseman LR (1999) Moxifloxacin. Drugs 57:363

    Article  Google Scholar 

  6. Blondeau JM (1999) A review of the comparative in-vitro activities of 12 antimicrobial agents, with a focus on five new ‘respiratory quinolones’. J Antimicrob Chemother 43(Suppl B):1

    Article  CAS  PubMed  Google Scholar 

  7. Gatifloxacin and moxifloxacin: two new fluoroquinolones. Med Lett Drugs Ther. 2000; 42:15

  8. Villafuerte-Gutierrez P, Villalon L, Losa JE, Henriquez-Camacho C. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol. 2014; Article ID 986938, 9 pages, 2014. doi:10.1155/2014/986938

  9. Gafter-Gvili A, Fraser A, Paul M et al (2012) Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev 1:CD004386

    PubMed  PubMed Central  Google Scholar 

  10. Bucaneve G, Micozzi A, Menichetti F et al (2005) Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 353(10):977–987

    Article  CAS  PubMed  Google Scholar 

  11. Garnica M, Nouér SA, Pellegrino FLPC, Moreira BM, Maiolino A, Nucci M (2013) Ciprofloxacin prophylaxis in high risk neutropenic patients: effects on outcomes, antimicrobial therapy and resistance. BMC Infect Dis 13:356

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Imran H, Tleyjeh IM, Arndt CAS et al (2008) Fluoroquinolone prophylaxis in patients with neutropenia: a meta-analysis of randomized placebo-controlled trials. Eur J Clin Microbiol Infect Dis 27:53

    Article  CAS  PubMed  Google Scholar 

  13. Gafter-Gvili A, Fraser A, Paul M, Leibovici L (2005) Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 142(12 Pt 1):979–995. doi:10.7326/0003-4819-142-12_Part_1-200506210-00008

    Article  PubMed  Google Scholar 

  14. Ganti BR, Marini BL, Nagel J, Bixby D, Perissinotti AJ (2017) Impact of antibacterial prophylaxis during reinduction chemotherapy for relapse/refractory acute myeloid leukemia. Support Care Cancer 25:541–547. doi:10.1007/s00520-016-3436-3

    Article  PubMed  Google Scholar 

  15. De Rosa FG, Motta I, Audisio E et al (2013) Epidemiology of bloodstream infections in patients with acute myeloid leukemia undergoing levofloxacin prophylaxis. BMC Infect Dis 13:563

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shinohara A, Yoshiki Y, Masamoto Y, Hangaishi A, Nannya Y, Kurokawa M (2013) Moxifloxacin is more effective than tosufloxacin in reducing chemotherapy-induced febrile neutropenia in patients with hematological malignancies. Leuk Lymphoma 54(4):794–798

    Article  CAS  PubMed  Google Scholar 

  17. von Baum H, Sigge A, Bommer A et al (2006) Moxifloxacin prophylaxis in neutropenic patients. J Antimicrob Chemothe 58:891–894

    Article  Google Scholar 

  18. Gerber B, Koppel J, Paul M et al (2014) Efficacy of anti-fungal but not anti-bacterial prophylaxis in intensive primary AML therapy: a real-world, retrospective comparative single-centre study. Swiss Med Wkly 144:w13985

    PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA

    Daniel J. Przybylski & David J. Reeves

  2. Department of Pharmacy, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA

    Daniel J. Przybylski & David J. Reeves

Authors
  1. Daniel J. Przybylski
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  2. David J. Reeves
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Correspondence to David J. Reeves.

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Przybylski, D.J., Reeves, D.J. Moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy. Support Care Cancer 25, 3715–3721 (2017). https://doi.org/10.1007/s00520-017-3797-2

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  • DOI: https://doi.org/10.1007/s00520-017-3797-2

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