Moxifloxacin versus levofloxacin for antibacterial prophylaxis in acute leukemia patients

• Published in: Journal of oncology pharmacy practice 2019-04, Vol.25 (3), p.758-761
• Main Authors: Lee, Pauline, Knoebel, Randall W, Pisano, Jennifer, Pettit, Natasha N
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Data processing; Female; Fever; Health care facilities; Humans; Infections; Intravenous administration; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Levofloxacin; Levofloxacin - therapeutic use; Male; Middle Aged; Moxifloxacin; Moxifloxacin - therapeutic use; Multivariate analysis; Neutropenia; Neutropenia - epidemiology; Prophylaxis; Regression analysis; Retrospective Studies; Risk factors
• ISSN: 1078-1552; 1477-092X
• DOI: 10.1177/1078155217752074

Objective The primary endpoint of this study was to determine the incidence of febrile neutropenia among patients receiving either moxifloxacin or levofloxacin for antibacterial prophylaxis. Secondary endpoints were number of documented infections and in-hospital mortality in patients who develop febrile neutropenia. Methods A single-center retrospective cohort analysis at a large tertiary care academic medical center was conducted. This study included adult acute leukemia patients (age ≥18 years old) who received inpatient antibacterial prophylaxis (moxifloxacin or levofloxacin) from 1 July 2012 to 1 October 2014. Patients were excluded from the study if they were treated with antimicrobial therapy in the preceding five days or admitted to the hospital with neutropenic fever. Fisher’s exact test was used for categorical data and Mann–Whitney test for continuous data. Logistic regression analysis was used to determine risk factors for febrile neutropenia. Results Eighty-five patients were included in the final analysis with 40 patients who received moxifloxacin and 45 patients who received levofloxacin. Baseline characteristics were similar between the two groups. Twenty-two patients experienced febrile neutropenia requiring intravenous antibiotics in the moxifloxacin group and 30 patients in the levofloxacin group (P = 0.190). Age and duration of neutropenia appeared to predict for febrile neutropenia; however, after multivariate analysis, longer duration of neutropenia was shown to be the best predictor for febrile neutropenia with an odds ratio of 4.69 (95% CI, 1.697–12.968). Both groups had similar rates of documented infections and in-hospital morality. Conclusion Moxifloxacin and levofloxacin showed similar rates of febrile neutropenia when used for neutropenic antibacterial prophylaxis in acute leukemia patients.