Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis

Abstract

BACKGROUND The purpose of the current study was to prevent bloodstream infection and invasive fungal infection (IFI) by administering prophylactic antibiotic and antifungal agents during intensive chemotherapy in patients being treated for acute leukemia. METHODS Prophylaxis treatment was administered during intensive chemotherapy in children with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) from January 1, 2010 to December 31, 2012. Oral ciprofloxacin (at a dose of 300 mg/m2/12 hours) was administered after chemotherapy when a patient with AML or ALL became neutropenic and > 7 days of neutropenia was expected. Voriconazole (at a dose of 4 mg/kg/12 hours) was initiated at the onset of neutropenia in patients with AML and after 7 days of neutropenia in patients with ALL. Micafungin (at a dose of 2 mg/kg/day) was substituted for voriconazole when patients with ALL received vincristine. Prophylaxis treatment was discontinued when the absolute neutrophil count recovered to > 100/μL. All episodes of bloodstream infection, IFI, febrile neutropenia, and intensive care unit stays related to severe infection occurring between January 1, 2005 and December 31, 2012 were recorded. RESULTS During the preprophylaxis period, 62 children with ALL and 24 children with AML experienced a total of 44 episodes of bloodstream infection and 22 episodes of IFI. Seven patients died of severe infection. In contrast, in the prophylaxis period, 10 episodes of bloodstream infection occurred and no IFIs were reported to occur in 51 patients with ALL and 14 patients with AML. Moreover, no patient died of severe infection. Episodes of febrile neutropenia and intensive care unit stay were significantly reduced during the prophylaxis period. CONCLUSIONS Prophylaxis with ciprofloxacin and voriconazole or micafungin was found to reduce the rates of bloodstream infection and IFI in children with acute leukemia undergoing intensive chemotherapy. Cancer 2014;120:1255–1262. © 2014 American Cancer Society.

Acute Myeloid Leukemia in Pediatric Patients: A Review About Current Diagnostic and Treatment Approaches

“…A retrospective study from St. Jude Children's Research Hospital (SJCRH) in patients with AML found that the use of intravenous cefepime or vancomycin in conjunction with oral ciprofloxacin or a cephalosporin significantly reduced the incidence of bacterial infection and sepsis compared with patients receiving only oral or no antibiotic prophylaxis [112]. Another retrospective study reported a significant reduction in Gram positive, sterilesite infections with antibiotic prophylaxis [113]. While it is suggested that antibiotic prophylaxis is beneficial, prospective randomized trials are required in pediatric patients with AML.…”

Approaches to the prevention of fungal infections in children after hematopoietic stem cell transplantation – the experience of the Russian Children's Clinical Hospital (Literature review and own experience)

“…Нейробластома 33 (20,4) Острый миелобластный лейкоз 29 (18) Острый лимфобластный лейкоз 20 (12,4) Ювенильный миеломоноцитарный лейкоз 11 (6,6) Первичный иммунодефицит В контексте данного исследования все пациенты получали препарат Вифенд (вориконазол) в качестве профилактики грибковой инфекции в средней дозе 9 мг/кг/сут в 2 приема каждые 12 ч с последующей под-держивающей дозой 8 мг/кг 2 раза в сутки. Важно от-метить, что в период с 2012 по 2013 г. препарат вводился внутривенно и в качестве таблетированных препара-тов, а начиная с 2014 г. появилась опция использования суспензии, что в ряде случаев (мукозит, малый возраст пациентов) позволило добиться лучшей приверженно-сти терапии.…”

“…Было показано, что вориконазол был эффективным и безопасным прежде всего для первичной и вторич-ной профилактики грибковых инфекций у детей при ТГСК и химиотерапии [17,18]. Эффективность данного препарата, по разным данным, составляет от 48 до 84 % [19,20].…”

Diagnosis and Treatment in Pediatric Acute Lymphoblastic Leukemia for General Pediatricians

“…The use of Dasatinib or imatinib in Ph (+) ALL may improve outcome. Prophylaxis with antibacterial and antifungal agents to patients with profound neutropenia in the early phase of therapy can decrease severe infections [12]. Overall, 6-7% of ALL patients need SCT, including those who relapses early.…”