Pharmaceutisch Weekblad

, Volume 9, Supplement 1, pp S45–S47 | Cite as

Ciprofloxacin for infection prevention in patients with acute leukemia

  • M. Rozenberg-Arska
  • A. W. Dekker


Ciprofloxacin, a new quinolone derivative, was given prophylactically (500 mg twice daily) to 15 patients with acute leukemia during remission induction treatment. The effect on the microbial flora of the alimentary tract was evaluated. A rapid elimination ofEnterobacteriaceae was observed.Bacteriodes andClostridium species were not affected. Few ciprofloxacin resistant strains were isolated but did not lead to colonization. In a randomized study 56 patients with acute leukemia received either ciprofloxacin or trimethoprim-sulfamethoxazole plus colistin for prevention of infections. Six major infections occurred in 28 patients receiving ciprofloxacin, and 11 major infections in 28 patients receiving trimethoprim-sulfamethoxazole plus colistin. No infections caused by Gramn-egative bacilli were seen in the ciprofloxacin group compared to 17 in the other group (p <0.02). Ciprofloxacin prevented colonization with resistant Gram-negative bacilli while 12 resistant colonizing strains were isolated from 10 patients receiving trimethoprim-sulfamethoxazole (p<0.01). Ciprofloxacin was better tolerated than trimethoprim-sulfamethoxazole+colistin; fewer side effects occurred.

Key words

Acute leukemia Ciprofloxacin Colistin Infection prophylaxis Selective decontamination Sulfamethoxazole Trimethoprim 


  1. 1.
    Young LS. Antimicrobial prophylaxis against infection in neutropenic patients (Editorial). J Infect Dis 1983;147:611–4.PubMedGoogle Scholar
  2. 2.
    Pizzo PA, Schimpff SC. Strategics for the prevention of infections in the myelosuppressed or immunosuppressed cancer patients. Cancer Treat Rep 1983;67:223–4.PubMedGoogle Scholar
  3. 3.
    Schimpff SC, Young VM, Greene WH, Vermeulen GD, Moody MR, Wiernik PH. Origin of infection in acute nonlymphocytic leukemia: Significance of hospital acquisition of potential pathogens. Ann Intern Med 1972;77:707–14.PubMedGoogle Scholar
  4. 4.
    Van der Waaij D, Berghuis-de Vries JM. Selective elimination of Enterobacteriaceae species from the digestive tract in mice and monkeys. J Hyg (Camb) 1974;72:205–11.Google Scholar
  5. 5.
    Sleijfer DT, Mulder NH, De Vries-Hospers HG, Fidler V, Nieweg HO, Van der Waaij D, Van Saene HKF. Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract. Eur J Cancer 1980;16:859–69.PubMedGoogle Scholar
  6. 6.
    Dekker AW, Rozenberg-Arska M, Sixma JJ, Verhoef J. Prevention of infection by trimethoprim/sulfamethoxazoleplus amphotericin B in patients with acute nonlymphocytic leukaemia. Ann Intern Med 1981;95:555–9.PubMedGoogle Scholar
  7. 7.
    Wade JC, De Jongh CA, Newman KA, Crowley J, Wiernik PH, Schimpff SC. Selective antimicrobial modulation as prophylaxis against infection during granulocytopenia: trimethoprim/sulfamethoxazole vs. nalidixic acid. J Infect Dis 1983;147:624–34.PubMedGoogle Scholar
  8. 8.
    Rozenberg-Arska M, Dekker AW, Verhoef J. Colistin and trimethoprim/sulfamethoxazole for the prevention of infection in patients with acute non-lymphocytic leukaemia. Decrease of emergence of resistant bacteria. Infection 1983;11:167–9.PubMedGoogle Scholar
  9. 9.
    Bauernfeind A, Petermuller C. In vitro activity of ciprofloxacin, norfloxacin and nalidixic acid. Eur J Clin Microbiol 1983;2:111–5.PubMedGoogle Scholar
  10. 10.
    Wise R, Andrews JM, Edwards LJ. In vitro activity of BAY 09867, a new quinolone derivative, compared with those of other antimicrobial agents. Antimicrob Agents Chemother 1983:23:599–64.Google Scholar
  11. 11.
    The quinolones (Editorial). Lancet 1984; 1:24–5.Google Scholar
  12. 12.
    Crump B, Wise R, Dent J. Pharmacokinetics and tissue penetration of ciprofloxacin. Antimicrob Agents Chemother 1983:24:784–6.PubMedGoogle Scholar
  13. 13.
    Rozenberg-Arska M, Dekker AW, Verhoef J. Ciprofloxacin for selective decontamination of the alimentary tract in patients with acute leukemia during remission induction treatment: the effect on faecal flora. J Infect Dis 1985;152:104–7.PubMedGoogle Scholar
  14. 14.
    Dekker AW, Rozenberg-Arska M, Verhoef J. Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med 1987;106:7–12.PubMedGoogle Scholar
  15. 15.
    Winston DJ, Ho WG, Nakao SL, Gale RP, Champlin RE. Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients. Am J Med 1986;80:884–90.PubMedGoogle Scholar
  16. 16.
    Karp JE, Hendricksen C, Redden T, Bartlett J. Double-blind randomized trial of oral prophylactic norfloxacin on infection in acute leukemia (Abstract 149). In: Proceedings of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington D.C.: American Society for Microbiology, 1985.Google Scholar
  17. 17.
    Bow EJ, Louie TJ, Rayner E, Pitsanuk J. Norfloxacin (N) versus trimethoprim/sulfamethoxazole (T/S) for infection prevention in patients (pts) with acute leukemia (AL) (Abstract 150). In: Proceedings of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington D.C.: American Society for Microbiology, 1985.Google Scholar

Copyright information

© Bohn, Scheltema & Holkema 1987

Authors and Affiliations

  • M. Rozenberg-Arska
    • 1
  • A. W. Dekker
    • 2
  1. 1.Department of Clinical Microbiology and Laboratory of Infectious DiseasesUniversity Hospital of UtrechtGV UtrechtThe Netherlands
  2. 2.Department of HematologyUniversity Hospital of UtrechtGV UtrechtThe Netherlands

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