Summary
In a prospective study patients with acute leukemia undergoing remission induction therapy were randomized to receive either a regimen of non-absorbable antimicrobial drugs (colistin and neomycin) or of absorbable and non-absorbable drugs (trimethoprim-sulfamethoxazole [TMP-SMZ] and colistin) for antibacterial prophylaxis. For antifungal prophylaxis patients in both groups were given oral amphotericin B. The proportion of patients without acquired infections and the median of study time to the first acquired infection did not differ significantly between the two treatment groups (p>0.05). Septicemias occurred in nine out of 49 recipients of colistin and neomycin and in one out of 56 patients receiving TMP-SMZ and colistin (p=0.03). Localized infections and fever episodes without proven infections were equally distributed between the two groups. The incidence of febrile days and of days on parenteral antibiotic therapy was significantly lower in the group given TMP-SMZ and colistin (p<0.05). The duration of severe granulocytopenia and thrombocytopenia did not differ significantly between the two groups (p>0.05).
Zusammenfassung
In einer randomisierten Studie wurde die Wirksamkeit von zwei Verfahren der Infektionsprophylaxe an Patienten mit akuten Leukämien untersucht. Die Patienten erhielten entweder eine Kombination nicht resorbierbarer Antibiotika (Colistin und Neomycin) oder eine Kombination resorbierbarer und nicht resorbierbarer antimikrobieller Substanzen (Trimethoprim-Sulfamethoxazol [TMP-SMZ] und Colistin). Zur Pilzprophylaxe wurde in beiden Gruppen Amphotericin B oral eingesetzt. Beide Gruppen unterschieden sich nicht signifikant hinsichtlich des Anteils von Patienten mit erworbenen Infektionen und hinsichtlich des Zeitintervalls bis zur ersten erworbenen Infektion (p>0,05). Septikämien traten bei neun von 49 Patienten auf, die Colistin und Neomycin erhielten, aber nur bei einem von 56 Patienten, die mit TMP-SMZ und Colistin behandelt wurden (p=0,03). Lokale Infektionen und Fieberepisoden ohne nachgewiesene Infektionen waren gleich häufig in beiden Gruppen. Die Häufigkeit von Fiebertagen und Tagen, an denen parenterale Antibiotika verabeicht wurden, war in der Gruppe, die TMP-SMZ und Colistin erhielt, signifikant geringer (p<0,05). Kein signifikanter Unterschied fand sich bei der Dauer der schweren Granulozytopenie und Thrombozytopenie (p>0,05).
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Kurrle, E., Dekken, A.W., Gaus, W. et al. Prevention of infection in acute leukemia: A prospective randomized study on the efficacy of two different drug regimens for antimicrobial prophylaxis. Infection 14, 226–232 (1986). https://doi.org/10.1007/BF01644268
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DOI: https://doi.org/10.1007/BF01644268