Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors

Abstract

Bacterial infections are the most common cause for treatment-related mortality in patients with neutropenia after chemotherapy. Here, we discuss the use of antibacterial prophylaxis against bacteria and Pneumocystis pneumonia (PCP) in neutropenic cancer patients and offer guidance towards the choice of drug. A literature search was performed to screen all articles published between September 2000 and January 2012 on antibiotic prophylaxis in neutropenic cancer patients. The authors assembled original reports and meta-analysis from the literature and drew conclusions, which were discussed and approved in a consensus conference of the Infectious Disease Working Party of the German Society of Hematology and Oncology (AGIHO). Antibacterial prophylaxis has led to a reduction of febrile events and infections. A significant reduction of overall mortality could only be shown in a meta-analysis. Fluoroquinolones are preferred for antibacterial and trimethoprim–sulfamethoxazole for PCP prophylaxis. Due to serious concerns about an increase of resistant pathogens, only patients at high risk of severe infections should be considered for antibiotic prophylaxis. Risk factors of individual patients and local resistance patterns must be taken into account. Risk factors, choice of drug for antibacterial and PCP prophylaxis and concerns regarding the use of prophylactic antibiotics are discussed in the review.

Bloodstream infections in neutropenic cancer patients: A practical update

“…5,8,[97][98][99] On the contrary, the Australian Consensus Guidelines recommend to consider the use of prophylaxis only for outpatients receiving HSCT and in palliative care patients with bone marrow failure. 18 All these recommendations are based on the results of 2 large randomized, double-blinded and placebo-controlled trials, published in 2005, which assessed the efficacy of levofloxacin during neutropenia in patients undergoing chemotherapy for solid cancers or acute leukemia.…”

Efficacy of antifungal prophylaxis with oral suspension posaconazole during induction chemotherapy of acute myeloid leukemia

“…For this reason, effective strategies of anti-infectious prophylaxis are indispensable to reduce the morbidity and mortality in AML patients (Neumann et al 2013). Posaconazole has been approved for antifungal prophylaxis in AML and MDS patients who are treated with intensive induction chemotherapy because of a reduced frequency of breakthrough fungal infections and even an increase in survival as compared to fluconazole and itraconazole (Cornely et al 2007).…”

Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: two parallel patient cohorts treated in a single center

“…14 Nevertheless, fluoroquinolones have been included in some, but not all, guidelines for the treatment of neutropenic AML patients. 1,3,15 The prevention and control of drug-resistant and multidrug-resistant pathogens are becoming increasingly challenging. Widespread antibiotic prophylaxis may promote the development of drug resistance.…”

“…[1][2][3] Patients with acute myeloid leukemia (AML) are at a particularly high risk. In addition to disease-and therapy-induced myelosuppression, disease-related conditions, such as alteration of the host defenses secondary to infiltration of the bone marrow and therapy-induced side effects (such as mucositis or diarrhea after breakdown of the mucosal barrier), further contribute to the high risk of infections.…”