Fosfomycin may be an effective antibacterial prophylactic alternative for patients with hematologic malignancies who develop febrile neutropenia and are not eligible for fluoroquinolone therapy, according to a study published in Supportive Care in Cancer.

Patients with hematologic disorders treated with chemotherapy commonly experience febrile neutropenia, which consequently increases the risk of lung, skin, blood, and gastrointestinal infections. Fluoroquinolones are utilized to prevent such infections, but recommendations for when fluoroquinolones are not a therapeutic option are unclear.

For this retrospective chart study, researchers identified 42 patients with hematologic malignancies who received prophylactic oral fosfomycin 3 g every 2 days for the duration of neutropenia or until occurrence of first fever. Eligible patients were fluoroquinolone intolerant, contraindicated for fluoroquinolone therapy, or had a history of resistant organisms.

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Diagnoses among the study participants were acute myeloid leukemia, multiple myeloma, and B-cell lymphoma. Of 42 patients, 25 were eligible for the study, 23 experienced febrile neutropenia, and a total of 8 (19%) breakthrough infections were identified.

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Upon microbiology results, organisms responsible for infections included Klebsiella spp, Streptococcus mitis/viridans, and coagulase-negative staphylococcus, which were responsible for urinary tract infections, cellulitis, and bacteremia.

The authors concluded that “given the low rate of breakthrough infections (19%), fosfomycin can be considered as an alternative agent for antibacterial prophylaxis in hematologic and HSCT patients who are unable to receive fluoroquinolone therapy.”


Zapolskaya T, Perreault S, McManus D, Topal JE. Utility of fosfomycin as antibacterial prophylaxis in patients with hematologic malignancies [published online January 10, 2018]. Support Care Cancer. doi: 10.1007/s00520-017-4040-x