Addition of doxycycline to ciprofloxacin for infection prophylaxis during autologous stem cell transplants for multiple myeloma
The most commonly used antibacterial prophylaxis during autologous stem cell transplants (ASCT) for multiple myeloma (MM) involves a fluoroquinolone, such as ciprofloxacin or levofloxacin. We assessed the impact of adding doxycycline to ciprofloxacin as routine antibacterial prophylaxis in these patients.
We retrospectively reviewed electronic medical records and our ASCT database to analyze rates and types of bacterial infections in MM patients who underwent ASCT in our institution.
Among 419 patients, 118 received ciprofloxacin alone (cipro group), and 301 ciprofloxacin and doxycycline (cipro-doxy group). Neutropenic fever (NF) developed in 63 (53%) and 108 (36%) patients of the cipro and cipro-doxy groups, respectively (p = 0.010). The number of documented bacteremic episodes was 13 (11%) and 14 (4.7%) in the two groups, respectively (p = 0.017). Antimicrobial resistance and Clostridium difficile infections were uncommon. Transplant-related mortality was 1% in both groups.
The addition of doxycycline to standard prophylaxis with ciprofloxacin seems to reduce the number of NF episodes and documented bacterial infections in patients with MM undergoing ASCT, without increasing rate of serious complications.
KeywordsDoxycycline High-dose melphalan Autologous stem cell transplant Infection prophylaxis Multiple myeloma
Jeffrey M. Sivik, PharmD: primary/corresponding author—responsible for drafting article, concept/design, data analysis/interpretation, critical revision of article, and final approval of article
Jo Ann Davidson, CRNP: responsible for data collection/analysis/interpretation, critical revision of article, and approval of article
Cory M. Hale, PharmD: responsible for data analysis/interpretation, critical revision of article, and approval of article
Joseph J. Drabick, MD: responsible for data analysis/interpretation, critical revision of article, and approval of article
Giampaolo Talamo, MD: senior author, responsible for concept/design, statistics, data collection/analysis/interpretation, critical revision of article, and approval of article
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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