Antibacterial prophylaxis with levofloxacin reduced the rate of infections overall in adult patients with relapsed/refractory acute myeloid leukemia (AML) without increasing the rates of multidrug-resistant organisms, a study published in the journal Supportive Care in Cancer has shown.1

For the retrospective, single-center, cohort study, researchers enrolled 145 patients with relapsed/refractory AML admitted for reinduction chemotherapy. Of those, 48 received levofloxacin prophylaxis at a dose of 500 mg orally once daily on day 1 of chemotherapy and 97 received no prophylaxis. Levofloxacin was continued until neutrophil recovery or hospital discharge.

Of note, patients receiving broad spectrum antibiotics on day 1 of reinduction or another prophylactic antibacterial agent were not included in the study.

Results showed that 37.5% of patients in the levofloxacin group developed bacteremia compared with 53.6% in the control group (P =.0789). Researchers found that this effect was largely due to a reduction in the rate of gram-negative bacteremia, as only 2.1% in the levofloxacin group had gram-negative bacteremia vs 21.6% in the control group (P =.001).

Investigators observed no significant differences in the incidence of neutropenic fever, incidence of multidrug resistance, length of hospitalization, or mortality between the 2 groups.

The findings ultimately suggest that the benefit of antibacterial prophylaxis in this treatment setting outweighs the risk, and therefore should be considered for patients receiving intensive chemotherapy for relapsed/refractory AML.

Reference

1. Ganti BR, Marini BL, Nagel J, Bixby D, Perissinotti AJ. Impact of antibacterial prophylaxis during reinduction chemotherapy for relapse/refractory acute myeloid leukemia. Supp Care Cancer. 2016 Oct 14. doi: 10.1007/s00520-016-3436-3. [Epub ahead of print]