Levofloxacin for Antibacterial Prophylaxis in Pediatric Patients With Acute Myeloid Leukemia or Undergoing Hematopoietic Stem Cell Transplantation

Abstract

OBJECTIVE This study aimed to evaluate the use of levofloxacin for the prevention of bacterial infections in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation. METHODS This study was a single-center, retrospective review designed to assess the frequency of bacteremia with levofloxacin prophylaxis compared with historical controls that used other, clinician-directed antibacterial prophylaxis. The primary outcome of the study was microbiologically documented bacteremia. Secondary outcomes included febrile neutropenia, clinically documented infection, duration of neutropenia, treatment antibiotic exposure days, Clostridioides difficile infection, and infection-related mortality. RESULTS Of the 60 patients included, 24 patients with 32 hospital admissions received levofloxacin and 36 patients with 48 hospital admissions received clinician-directed prophylaxis. There was no difference found in the frequency of bacteremia between levofloxacin and clinician-directed prophylaxis (15.6% vs 10.4%, p = 0.49). There was no difference in the incidence of febrile neutropenia, clinically documented infection, treatment antibiotic exposure days, or 30-day infection-related mortality between the 2 groups. The levofloxacin group had a longer mean duration of neutropenia compared with clinician-directed prophylaxis (26.8 days vs 16.4 days, p = 0.01). CONCLUSIONS There was no difference in bacteremia between levofloxacin prophylaxis and clinician-directed prophylaxis in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation. Levofloxacin prophylaxis is an appropriate alternative for the prevention of serious bacterial infections in this patient population, although further studies are needed to confirm these results.

Spectrum of infections in different regimens of post-induction chemotherapy in acute myeloid leukemia (de-novo): A comparative retrospective study

“…The administration of LIIC has been shown to significantly increase the chances of survival in people with AML who are either too old or have other health problems that prevent them from receiving high-dose therapies [ 1 , [5] , [6] , [7] , [8] , [9] , [10] ]. However, getting infections while taking LITR can be a problem, which could make the survival benefits of these drugs less effective [ 3 , 12 , [18] , [19] , [20] , [21] , [22] , [23] , [24] ].…”

“…The percentage of complete remission after receiving HIIC lies between 39 and 65% [ 5 ]. Patients acquiring complete remission and not undergoing consolidating therapies have an increased risk of mortality [ [5] , [6] , [7] ].…”

“…However, a large number of individuals are first diagnosed with AML at a median age of 68–70 and have substantial co-morbidities that generally preclude them from benefiting from these treatments [ 3 , 5 ]. Even though present treatment options enable around 90 % of cancer patients to survive the condition, several individuals die due to relapse of disease or infectious and non-infectious disorders [ 7 ]. The likelihood of morbidity and mortality is raised by the occurrence of infections in AML patients, as they are more susceptible to induction chemotherapy.…”

Levofloxacin Versus Ciprofloxacin-Based Prophylaxis during the Pre-Engraftment Phase in Allogeneic Hematopoietic Stem Cell Transplant Pediatric Recipients: A Single-Center Retrospective Matched Analysis

“…Other studies revealed a decrease in the incidence of bacteremia in patients taking levofloxacin compared to other prophylaxis or placebo [ 31 , 32 ]. However, in the pediatric population, the literature presents no differences in the incidence of bacteremia between the group treated with levofloxacin and other prophylaxis, such as cefepime with or without vancomycin or no prophylaxis [ 5 , 20 , 22 ]. The study conducted by Alexander et al proved a reduction in the incidence of bacteremia in children with acute myeloid leukemia receiving levofloxacin prophylaxis compared to the control group without prophylaxis (21.9% vs. 43.4%, p < 0.001).…”

“…Bloodstream infections (BSI) are frequent and life-threatening complications in HSCT recipients, particularly during pre-engraftment [ 2 , 3 , 4 ]. The incidence of BSI in pediatric HSCT recipients is reported, in the literature, between 20% and 44% [ 5 ]. Approximately 40% of all BSI are related to at least one adverse outcome, constituting a significant burden to the pediatric HSCT population [ 6 ].…”