Prophylactic Co‐trimoxazole and lactobacilli preparation in neutropenic patients

Abstract

A randomized study of intestinal decontamination was undertaken in 68 children with leukemia and solid tumours. Framycetin, colymycin, nystatin, and metronidazole were given in 35 neutropenic episodes in 33 children, while co-trimoxazole and lactobacilli preparation were administered in 35 episodes in 35 children. The diseases, severity of neutropenia, and incidence of infection at entry into study were comparable in the two groups. There was no significant difference in the incidence of infections developing during the phase of neutropenia. The median and range of time required to recover from neutropenia were also not different. Co-trimoxazole and lactobacilli were significantly better tolerated, there being no nausea and vomiting, no refusal to take medication, no dose reduction or change to an alternative regimen. We conclude that co-trimoxazole and lactobacilli preparation improve quality of life during a neutropenic episode and have the additional advantage of being relatively inexpensive.

Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

“…The randomised trials were excluded for the following reasons: peri-procedural (central line insertion) prophylactic antibiotic administration (Ljungman 1997),vancomycin solution administration for prevention of catheter infection (Barriga 1997),high attrition (EORTC 1982),prophylactic antibiotic therapy combined with a protected environment (Lohner 1979),prophylactic antibiotic therapy combined with lactobacilli (Ekert 1980),the intervention evaluated was granulocyte colony stimulating factor and both arms received prophylactic antibiotics (Timmer-Bonte 2005),seven reports were identified as duplicate publications and were considered under their primary references (Bow 1984;Castagnola 2003; Donnelly 1992b; Harousseau 1987; Karp 1987; Sleijfer 1980; Winston 1986). …”

Anti-proliferative effect of two lactic acid bacteria strains of human origin on the growth of a myeloma cell line

“…1998). Clinical trials have indicated that lactobacilli‐containing preparations improve the quality of life of children with leukaemia or solid tumours during neutropenic episodes (Ekert et al . 1980).…”

Antimicrobial Prophylaxis and Modifications of the Gut Microbiota in Children with Cancer

“…Probiotic supplementation has been widely studied in children presenting various health conditions [98][99][100][101][102][103][104], whereas there have been very few studies regarding gut microbiota dysbiosis in pediatric patients with cancer. The first one was published in 1980 [105] and was also one of the first works that examined the concept of intestinal decontamination, that is, a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. In a group of 68 children with leukemia and solid tumors, 35 neutropenic episodes in 33 children were treated with framycetin, colymycin, nystatin, and metronidazole, while the other 35 episodes in the remaining 35 children were cured with TMP-SMX and Lactobacillus preparations [105].…”

“…The first one was published in 1980 [105] and was also one of the first works that examined the concept of intestinal decontamination, that is, a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. In a group of 68 children with leukemia and solid tumors, 35 neutropenic episodes in 33 children were treated with framycetin, colymycin, nystatin, and metronidazole, while the other 35 episodes in the remaining 35 children were cured with TMP-SMX and Lactobacillus preparations [105]. Even if there was no significant difference in the incidence of infections during the period of neutropenia, the second group had better tolerance to the medication, so the authors concluded that a TMP-SMX and Lactobacillus preparation may improve quality of life in neutropenic children and is also relatively inexpensive [105].…”

“…In a group of 68 children with leukemia and solid tumors, 35 neutropenic episodes in 33 children were treated with framycetin, colymycin, nystatin, and metronidazole, while the other 35 episodes in the remaining 35 children were cured with TMP-SMX and Lactobacillus preparations [105]. Even if there was no significant difference in the incidence of infections during the period of neutropenia, the second group had better tolerance to the medication, so the authors concluded that a TMP-SMX and Lactobacillus preparation may improve quality of life in neutropenic children and is also relatively inexpensive [105]. Finally, Wada et al [106] demonstrated that children with cancer receiving Bifidobacterium breve strain Yakult had decreased levels of Enterobacteriaceae in their stool and, more importantly, children assigned to the probiotic group had fewer febrile episodes (0.5 ± 0.62, 95% confidence interval [CI]: 0.21-0.79 and 1.06 ± 1.80, 95% CI: 0.19-1.93) than did children assigned to the placebo group (0.95 ± 0.79, 95% CI: 0.62-1.28 and 3.00 ± 3.84, 95% CI: 1.39-4.61), thus indicating lower usage of antibiotics.…”