Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions

Lee, Samantha S. F.; Fulford, Adrienne; Quinn, Maureen; Seabrook, Jamie A.; Rajakumar, Irina

doi:10.1007/s00520-017-3976-1

Cited by 7 publications

(13 citation statements)

References 11 publications

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“…36,37 The need for fluoroquinolone prophylaxis also in AML patients has been considered. 26,38,39 In the study by Castañón et al, 40 fluoroquinolone prophylaxis reduced the incidence of Gram-negative bacterial infections during the TA B L E 4 Factors affecting Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) score (qSOFA score ≥ 1 and qSOFA score ≥ 2), and predictors for intensive care unit (ICU) admission and infectious mortality during FN in 355 febrile neutropenia periods of 125 AML patients consolidation treatments. The other side of the coin is the threat of multidrug resistance, which has even been reported to influence the clinical course of AML.…”

Section: Discussion and Con Clus I Onmentioning

confidence: 99%

“…The frequency of Gram‐negative bacteremia, for example, Escherichia coli , known to be associated with substantial mortality, has increased as a cause of sepsis 36,37 . The need for fluoroquinolone prophylaxis also in AML patients has been considered 26,38,39 . In the study by Castañón et al, 40 fluoroquinolone prophylaxis reduced the incidence of Gram‐negative bacterial infections during the consolidation treatments.…”

Section: Discussionmentioning

confidence: 99%

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Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

Lappalainen

Hämäläinen

Romppanen

et al. 2020

European J of Haematology

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Objectives: To evaluate quick Sequential Organ Failure Assessment (qSOFA) score during febrile neutropenia (FN) in adult patients receiving intensive chemotherapy for acute myeloid leukemia (AML). Methods: qSOFA score, as well as the association of qSOFA score with ICU admission, infectious mortality, blood culture findings, and C-reactive protein (CRP) measurements during FN were assessed among 125 adult AML patients with 355 FN periods receiving intensive chemotherapy in a tertiary care hospital from November 2006 to December 2018. Results: The multivariate model for qSOFA score ≥ 2 included CRP ≥ 150 mg/L on d0-2 [OR 2.9 (95% CI 1.1-7.3), P = .026], Gram-negative bacteremia [OR 2.7 (95% CI 1.1-6.9), P = .034], and treatment according to AML-2003 vs more recent protocols [OR 2.7 (95% CI 1.0-7.4), P = .047]. Age or gender did not gain significance in the model. qSOFA score ≥ 2 was associated with ICU treatment and infectious mortality during FN with sensitivity and specificity of 0.700 and 0.979, and 1.000 and 0.971, respectively. Conclusion: qSOFA offers a useful tool to evaluate the risk of serious complications in AML patients during FN.

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Section: Discussion and Con Clus I Onmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

Lappalainen

Hämäläinen

Romppanen

et al. 2020

European J of Haematology

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“…Third, the true benefit of levofloxacin prophylaxis in preventing FN in intermediate-risk patients may also be smaller than described, leaving us underpowered to adequately assess the impact of body size on FN in this study. As the benefit of levofloxacin prophylaxis has been best described in high-risk groups, [8][9][10][11][12][13][14][15][16] future studies in high-risk populations might be better suited to assess the impact of body size on FN during levofloxacin prophylaxis. Lastly, FN may be attributable to factors that are not related to the adequacy of prophylaxis regimens.…”

Section: Discussionmentioning

confidence: 99%

Obesity is not strongly associated with increased risk for febrile neutropenia during levofloxacin prophylaxis in patients with hematological malignancies receiving intermediate-risk myelosuppressive chemotherapy

Kurtti

Fritz

Elofson-Disney

et al. 2019

J Oncol Pharm Pract

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Levofloxacin given at a standard dose of 500 mg daily is recommended for antibacterial prophylaxis in patients receiving myelosuppressive chemotherapy. Obese patients have been shown to exhibit enhanced clearance of levofloxacin and may be at risk for prophylactic failure. This single center, retrospective cohort study from June 2014 to May 2017 evaluated adult patients with estimated creatinine clearance ≥50 mL/min receiving their first cycle of a National Comprehensive Cancer Network defined intermediate-risk regimen. Primary endpoint was incidence of febrile neutropenia. Secondary endpoints included 30-day mortality and the correlation between estimated levofloxacin area under the concentration–time curve and rates of febrile neutropenia. Febrile neutropenia occurred in 26 patients: 12 (35.3%) obese and 14 (21.9%) non-obese ( P = 0.16). Six (23.1%) of these patients required intensive care, but there were no deaths within 30 days of a febrile neutropenia event. Estimated creatinine clearance was similar between obese and non-obese patients (median 97.5 vs. 91.8 mL/min, P = 0.39), as was estimated levofloxacin area under the concentration–time curve (median 85.6 vs. 90.8 mg×h/L, P = 0.39). There were no significant associations between body weight-related variables – total body weight (median 83.4 vs. 80.6 kg, P = 0.51), body mass index (mean 29.6 vs. 26.8 kg/m2, P = 0.35), or body surface area (1.98 vs. 1.99 m2, P = 0.68) – and febrile neutropenia in this cohort of patients with similar renal function. Obesity should not be a justification for more aggressive levofloxacin dosing schemes when used for febrile neutropenia prophylaxis.

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“…We teremia with and without prophylaxis. 1,2,4,7,[11][12][13][14][15][16][17] Published literature was used to estimate the probability of ICU admission or death, with or without bacteremia. 4,5,11,15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The probability of levofloxacinrelated adverse events was estimated using the FDA-approved package insert.…”

Section: Model Parametersmentioning

confidence: 99%

“…Egan et al noted differences in findings may be due to more strict inclusion criteria and analysis of more recently published trials in the former 54. Multiple studies have found no increased risk in Clostridium difficile infection with levofloxacin prophylaxis, with some studies even noting a significant decrease in infection rates 7,14,56. Despite concerns regard-ing fluoroquinolone exposure in pediatric patients, long-term results of an observational surveillance study of over 1000 children on phase III trials found the medication was well tolerated overall.…”

mentioning

confidence: 99%

Cost‐effectiveness of levofloxacin prophylaxis against bacterial infection in pediatric patients with acute myeloid leukemia

McCormick

Friehling

Kalpatthi

et al. 2020

Pediatric Blood & Cancer

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Background Infections are the leading cause of therapy‐related mortality in pediatric patients with acute myeloid leukemia (AML). Although effectiveness of levofloxacin antibacterial prophylaxis in oncology patients is recognized, its cost‐effectiveness is unknown. This study evaluated epidemiologic data regarding levofloxacin use and the cost‐effectiveness of this strategy as the cost per bacteremia episode, intensive care unit (ICU) admission, and death avoided in children with AML. Procedure A retrospective cohort study using the Pediatric Health Information System (PHIS) database compared demographic and clinical characteristics and receipt of levofloxacin prophylaxis in children with AML admitted for chemotherapy from January 1, 2014, through December 31, 2018. We then developed a decision analysis model in this population that compared costs associated with bacteremia, ICU admission, or death secondary to bacteremia to levofloxacin prophylaxis cost from a healthcare perspective. Time horizon is one chemotherapy cycle. Probabilistic and one‐way sensitivity analyses evaluated model uncertainty. Results Prophylaxis cost $8491 per bacteremia episode prevented compared with an average added hospital cost of $119 478. Prophylaxis cost $81 609 per ICU admission avoided, compared with an average added hospital cost of $94 181. Prophylaxis cost $220 457 per death avoided. In sensitivity analysis, at a willingness‐to‐pay threshold of $100 000 per bacteremia episode avoided, prophylaxis remained cost‐effective in 94.6% of simulations. Prophylaxis use was more common in recent years in patients with relapsed disease and with chemotherapy regimens considered more intensive. Conclusion Prophylaxis is cost‐effective in preventing bacterial infections in patients with AML. Findings support increased use in patients considered at high risk of bacterial infection secondary to myelosuppression.

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Levofloxacin for febrile neutropenia prophylaxis in acute myeloid leukemia patients associated with reduction in hospital admissions

Abstract: Prescribing oral levofloxacin post-consolidation chemotherapy in AML patients is associated with a reduction in febrile neutropenia. Further research is required to identify the impact on fluoroquinolone resistance and risk of CDAD.

Cited by 7 publications

References 11 publications

Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

Obesity is not strongly associated with increased risk for febrile neutropenia during levofloxacin prophylaxis in patients with hematological malignancies receiving intermediate-risk myelosuppressive chemotherapy

Cost‐effectiveness of levofloxacin prophylaxis against bacterial infection in pediatric patients with acute myeloid leukemia

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