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Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions

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Abstract

Purpose

The purpose of this study is to evaluate the efficacy and safety of prophylactic oral levofloxacin in acute myeloid leukemia (AML) patients after receiving consolidation chemotherapy to prevent febrile neutropenia.

Methods

We conducted a retrospective chart review of 50 AML patients who were prescribed levofloxacin and 50 AML patients who were not prescribed levofloxacin post-consolidation chemotherapy between June 2006 and August 2013 at a tertiary academic medical center. The primary outcome of this study was to evaluate the effectiveness of levofloxacin in preventing hospital readmission due to febrile neutropenia. Secondary outcomes evaluated the safety of this therapy, including the rate of Clostridium difficile-associated diarrhea (CDAD) within 30 days from discharge of receiving consolidation chemotherapy and rate of fluoroquinolone resistance in positive bacterial cultures.

Results

Hospital readmission due to febrile neutropenia after the first consolidation cycle occurred in 42% of patients prescribed levofloxacin, as compared to 72% that were not prescribed levofloxacin (p = 0.002). This was also significantly reduced when levofloxacin was prescribed after all consolidation cycles (51.4 vs. 67%, p = 0.023). CDAD did not occur in any patient prescribed levofloxacin after the first cycle, compared to one case in those not prescribed levofloxacin. Evaluation of the impact on fluoroquinolone resistance was limited due to a paucity of fluoroquinolone susceptibilities reported.

Conclusions

Prescribing oral levofloxacin post-consolidation chemotherapy in AML patients is associated with a reduction in febrile neutropenia. Further research is required to identify the impact on fluoroquinolone resistance and risk of CDAD.

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Acknowledgements

Samantha Lee conducted this study as part of a hospital pharmacy residency program at London Health Sciences Centre. Irina Rajakumar was the hematology-oncology pharmacist at London Health Sciences Centre at the time this study was completed.

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Authors and Affiliations

  1. Pharmacy Department, St. Michael’s Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    Samantha S. F. Lee

  2. Department of Hematology, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada

    Adrienne E. Fulford & Maureen A. Quinn

  3. Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada

    Jamie Seabrook

  4. Department of Pharmacy, Alberta Health Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada

    Irina Rajakumar

Authors
  1. Samantha S. F. Lee
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  2. Adrienne E. Fulford
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  3. Maureen A. Quinn
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  4. Jamie Seabrook
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  5. Irina Rajakumar
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Correspondence to Samantha S. F. Lee.

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Lee, S.S.F., Fulford, A.E., Quinn, M.A. et al. Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions. Support Care Cancer 26, 1499–1504 (2018). https://doi.org/10.1007/s00520-017-3976-1

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  • DOI: https://doi.org/10.1007/s00520-017-3976-1

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