Moxifloxacin prophylaxis in neutropenic patients

• Published in: Journal of antimicrobial chemotherapy 2006-10, Vol.58 (4), p.891-894
• Main Authors: von Baum, H., Sigge, A., Bommer, M., Kern, W. V., Marre, R., Döhner, H., Kern, P., Reuter, S.
• Format: Article
• Language: English
• Subjects: anaerobes; Anti-Infective Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Aza Compounds - therapeutic use; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - prevention & control; Bacteria; Biological and medical sciences; Chemotherapy; Clinical trials; Clostridium difficile; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - microbiology; fluoroquinolones; Fluoroquinolones - therapeutic use; Gram-Negative Bacteria - drug effects; Gram-Positive Bacteria - drug effects; Hematologic and hematopoietic diseases; Humans; Infections; Leukemia; Levofloxacin; Medical sciences; neutropenia; Neutropenia - complications; Ofloxacin - therapeutic use; Other diseases. Hematologic involvement in other diseases; Pharmacology. Drug treatments; Quinolines - therapeutic use
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkl320

Objectives: Recent studies have shown a beneficial impact of fluoroquinolones on infection-related morbidity and mortality for patients with haematological malignancies during neutropenia. Among the fluoroquinolones moxifloxacin currently provides one of the broadest spectra of antibacterial activity and may be suitable for prophylaxis during neutropenia. Patients and methods: In this controlled before and after observational study, moxifloxacin chemoprophylaxis was used during prolonged neutropenia in haemato-oncological patients (period 2; 282 episodes). Data were compared with two periods with levofloxacin prophylaxis, one preceding period (period 1; 399 episodes) and a post-observational period (period 3; 53 episodes). Endpoints for evaluation were the rates of Gram-negative and Gram-positive bacteraemia and infection-related mortality. Results: We found similar survival rates as compared with levofloxacin. The rate of Gram-negative bacteraemia was higher during prophylaxis with moxifloxacin (11%) when compared with levofloxacin (6% for period 1 and 6% for period 3). In addition we observed a marked increase in diarrhoea associated with Clostridium difficile toxin A (CDAD) after a formula change from levofloxacin to moxifloxacin (attack rate 6% versus 33%). A decrease was attained after changing back to levofloxacin and reinforcing hygienic measures (13%). Conclusions: During moxifloxacin prophylaxis, we observed a significantly increased incidence of Gram-negative bacteraemia and CDAD. Careful attention must be paid not to trade the particularly beneficial effects of fluoroquinolones in the neutropenic setting for such disadvantageous effects. Until further data are obtained, caution is warranted when applying fluoroquinolones with high anaerobic activity in the neutropenic setting.