Selective suppression of alimentary tract microbial flora as prophylaxis during granulocytopenia

Hargadon, M. T.; Young, Viola Mae; Schimpff, Stephen C.; Wade, James C.; Minah, Glenn E.

doi:10.1128/aac.20.5.620

Cited by 52 publications

(11 citation statements)

References 9 publications

(4 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is of particular concern in leukemic patients, in whom infection by newly acquired gram-negative bacilli is a major cause of morbidity and mortality (12,29). It has been recommended that the regimens used for antibiotic prophylaxis in these patients be chosen with a view to sparing the anaerobic component of the fecal microflora (12,13,30). Thus, physicians are acting upon the unproven assumption that there is a phenomenon of colonization resistance in humans and that it is related in particular to the anaerobic microflora.…”

Section: Downloaded Frommentioning

confidence: 99%

Effect of broad-spectrum parenteral antibiotics on "colonization resistance" of intestinal microflora of humans

Barza¹,

Giuliano²,

Jacobus³

et al. 1987

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Studies with animals have shown that the normal intestinal microflora protects against colonization by new strains ("colonization resistance") and that this protective effect may be related to the anaerobic component of the microflora. However, colonization resistance has not been shown in humans. We administered cefoxitin, piperacillin, cefoperazone, and aztreonam intravenously to healthy subjects for 9 days and monitored the acquisition of new isolates in the fecal flora. Seven of sixteen antibiotic-treated subjects but none of four untreated controls became colonized by gram-negative bacilli. However, there was no correlation between colonization and the particular drug given or the extent of suppression of anaerobes or of any other component of the fecal microflora. Cefoxitin and piperacillin were associated with the greatest increases in the numbers of drug-resistant bacteria and in fecal beta-lactamase content. The results of this study support the concept that colonization resistance occurs in humans and is diminished by antibiotic administration but fail to support the hypothesis that resistance is related to the anaerobic microflora.

show abstract

Section: Downloaded Frommentioning

confidence: 99%

Effect of broad-spectrum parenteral antibiotics on "colonization resistance" of intestinal microflora of humans

Barza¹,

Giuliano²,

Jacobus³

et al. 1987

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…The principle of selective decontamination of the gastrointestinal tract has been applied successfully to reduce endogenous infection in severely immunocompromised patients: oral antibiotics are used to eliminate the aerobic potentially pathogenic gram-negative organisms in the intestine while preserving the normally predominant anaerobic flora (2,7,8,16,24).…”

mentioning

confidence: 99%

Effects on oral and intestinal microfloras of norfloxacin and pefloxacin for selective decontamination in bone marrow transplant patients

Giuliano

Pantosti

Gentile

et al. 1989

Antimicrob Agents Chemother

View full text Add to dashboard Cite

We monitored the modifications of oral and intestinal microfloras of 10 allogeneic bone marrow recipients who received randomly either norfloxacin or pefloxacin (400 mg three times a day) as selective decontamination for infection prevention. After 1 week of treatment, in all patients members of the family Enterobacteriaceae were no longer detectable and in all but one pefloxacin-treated patient enterococci were also eliminated in the intestine. The anaerobic flora was not affected, with the exception of Bacteroides spp., markedly reduced after treatment with pefloxacin. In most patients the most striking effect was the increase in staphylococcal counts. These strains were found to be resistant to both quinolones in the study. Less consistent changes were observed in oral flora. No relevant difference could be demonstrated between the two regimens on bacterial counts either in feces or in saliva. This study shows the efficacy of both quinolones in eradicating gram-negative bacilli in the alimentary tract of bone marrow transplant patients; however, the finding of the overgrowth of resistant gram-positive organisms during treatment with these agents deserves further evaluation.Infection is the most frequent complication and a major cause of death in patients with profound and prolonged granulocytopenia (11). The principle of selective decontamination of the gastrointestinal tract has been applied successfully to reduce endogenous infection in severely immunocompromised patients: oral antibiotics are used to eliminate the aerobic potentially pathogenic gram-negative organisms in the intestine while preserving the normally predominant anaerobic flora (2,7,8,16,24).Fluoroquinolones, a new class of antibiotics (9, 23) highly active against aerobic gram-negative bacilli, are currently being tested as selective prophylactic regimens during neutropenia. Studies with norfloxacin have been carried out and have demonstrated its efficacy in eliminating gram-negative rods from the intestine of treated patients while sparing the other components of the microflora; this effect was reflected by a decrease in the morbidity associated with gram-negative infections (12, 21). Pefloxacin, one of the newer fluoroquinolones, has a better systemic absorption compared with norfloxacin (22) and could have a prophylactic effect also against bacterial infections originating outside the gastrointestinal tract (e.g., the oral cavity); furthermore, because of the broader spectrum of activity of pefloxacin (3), it might also be a better agent for preventing infections caused by gram-positive organisms.Therefore, we carried out a comparative microbiological study with a group of severely immunocompromised patients as allogeneic bone marrow recipients who received either norfloxacin or pefloxacin as antibiotic prophylaxis. We evaluated the efficacy of the two quinolones in decontaminating the alimentary tract by monitoring the modifications of oral and intestinal microfloras and the emergence of resistant strains.(This work was presented in part...

show abstract

“…Although it is difficult to extrapolate directly from mice, similar outgrowth of enterococci after parenteral Ctx may occur in humans (Lambert-Zechovsky et al 1985). Many patients to whom SDD is of potential benefit are severely immunocompromised (Guiot et al 1983;Hargadon et al 1981;Heimdahl et al 1984;Sleijfer et al 1980) and under these conditions a rise in any intestinal bacterial group with possibly enhanced translocation to spleen and lymph nodes may be hazardous.…”

Section: Discussionmentioning

confidence: 99%

“…This maintenance of the anaerobic flora prevents overgrowth by drugresistant aerobes, a phenomenon termed colonization resistance (CR) (van der Waaij, Berghuis-de Vries & Lekkerkerk-van der Wees, 1972). In humans, such techniques have been used with some success to reduce infection of endogenous origin in granulocytopoenic patients (Guiot et al 1983;Hargadon et al 1981;Sleijfer et al 1980). Recently, SDD has been applied to patients in an intensive therapy unit (ITU) and has achieved a striking reduction in infection rates (Stoutenbeek et al 1984).…”

Section: Introductionmentioning

confidence: 99%

The effect of selective decontamination of the digestive tract with the addition of systemic cefotaxime on the aerobic faecal flora of mice

et al. 1987

View full text Add to dashboard Cite

SUMMARYThe administration per-orally to mice of the non-absorbable antibiotics polymyxin E, tobramycin and amphotericin B resulted in the elimination of detectable aerobic gram-negative rods from the faecal flora without affecting the total viable aerobic count. The addition of parental cefotaxime to the regime caused a fall in the number of aerobic lactobacilli and an increase in the number of enterococci. The rise was associated with the translocation of viable enterococci to the mesenteric lymph nodes and the spleen. The changes induced by cefotaxime were reversed when the antibiotic was withdrawn. Following withdrawal of all antibiotics the total aerobic faecal flora increased to above normal levels, but there was no associated diarrhoea. Attempts to implant exogenous enterobacteria into the digestive tract resulted in only low level colonization both in treated mice and in control mice. These results may have implications for the use of this antibiotic regime for selective decontamination of the digestive tract in humans, particularly those who are immunocompromised.

show abstract

Selective suppression of alimentary tract microbial flora as prophylaxis during granulocytopenia

Cited by 52 publications

References 9 publications

Effect of broad-spectrum parenteral antibiotics on "colonization resistance" of intestinal microflora of humans

Effect of broad-spectrum parenteral antibiotics on "colonization resistance" of intestinal microflora of humans

Effects on oral and intestinal microfloras of norfloxacin and pefloxacin for selective decontamination in bone marrow transplant patients

The effect of selective decontamination of the digestive tract with the addition of systemic cefotaxime on the aerobic faecal flora of mice

Contact Info

Product

Resources

About