Benefit of Prophylaxis by Intravenous Systemic Vancomycin in Granulocytopenic Patients: A Prospective, Randomized Trial among 59 Patients

Abstract

We have tested the benefit of prophylaxis by intravenous systemic vancomycin among 59 neutropenic patients in a randomized trial. Vancomycin was delivered on day zero of chemotherapy until the resolution of neutropenia in the prophylactic group (vanco+). Empiric antibiotic therapy (piperacillin, ofloxacine) was identical for all patients. The number of days with fever > 38.5 °C was significantly higher in the control (vanco-) group than in the vanco+group (7.4 vs. 3.7, p < 0.02). Zero gram-positive infections occurred in the vanco+ group versus 9 in the vanco- group (p < 0.002). The mean number of days of empiric antibiotic therapy was reduced in the vanco+group (11.3 vs. 16.3, p = 0.12). However, no benefit was noted between the two groups with regard to mortality or the severity of the infections. The selection of resistant microorganisms after systemic treatment with vancomycin is of potential risk. Such a prophylactic antibiotic regimen does not seem to be justified.

Science and pragmatism in the treatment and prevention of neutropenic infection

“…The prevention of Grampositive infections is more difficult; co-trimoxazole and penicillin have been used and found to be effective. 20,22,23 The main problem with chemoprophylaxis is the emergence of resistance; however, since the antibiotics used for chemoprophylaxis in cancer patients are widely used in the community, it is unlikely that their use in neutropenic patients will significantly aggravate the overall situation. Therefore, since chemoprophylaxis with quinolones has to date proved very efficacious in preventing Gram-negative infection during neutropenia, it would appear unwise to deny it to our patients.…”

“…In some centres, the problem of streptococcal infections, namely in bone marrow transplant recipients, has been solved by the pre-emptive use of vancomycin. 19,20 Excessive use of glycopeptides could lead to the emergence of resistance to vancomycin in other bacterial species, such as staphylococci, so other approaches have been used. These include the administration, as a first-line therapy, of piperacillin-tazobactam, in combination with amikacin.…”

Alternative Therapies for Neonatal Autoimmune Thrombocytopenia

“…In all patients, platelet counts rose twofold on the 3rd day and fourfold on the 5th day of treatment. Özsoylu et al [15, 16, 17, 18] reported successful results with high-dose methylprednisolone in children with acute and chronic ITP. They also showed that high-dose methylprednisolone was superior to IVIG.…”

Treatment of neutropenic infection: trends towards monotherapy?

“…In some centers, the problem of streptococcal infections, namely in bone marrow-transplanted patients, has been solved by the preemptive use of vancomycin [1,17]. However, to avoid excessive use of glycopeptides, which can lead to the emergence of resistance to vancomycin, a resistance that might be passed to other bacterial species, namely staphylococci, other approaches have been used.…”