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Prophylactic use of antibiotics reduces the incidence of intensive treatment of acute myeloid leukemia in children

The purpose of a study in the United States was to determine whether the prescription of prophylactic antibiotics during neutropenia affects the decrease in the incidence of streptococcal sepsis caused by S. viridans and, in general , on the incidence of sepsis due to bacterial pathogens.

The authors evaluated the results in 78 patients who received treatment for acute myeloid leukemia from October 2002 to January 2007. Several consecutive antibiotic prophylaxis regimens were used. All patients received oral antifungal prophylaxis with voriconazole.

It has been shown that cephalosporins for oral administration do not significantly reduce both the risk of developing bacterial sepsis (p = 0.81) and the likelihood of sepsis caused by S. viridans (p = 0.9) compared to the lack of prophylactic use of antibiotics. Intravenous administration of cefepime completely prevents the occurrence of streptococcal sepsis and reduces the probability of developing bacterial sepsis by 91% (p less than 0.0001) compared to the absence of antibiotic prophylaxis. The combination of vancomycin with oral ciprofloxacin or cephalosporin reduces the risk of bacterial sepsis by 93% (p less than 0.0001) and streptococcal septicemia by 99% (p less than 0.0001). The incidence of fungal infections did not differ significantly between patients who received and did not receive prophylactic antimicrobial drugs. The observed decrease in mean length of hospital stay for chemotherapy courses in patients receiving vancomycin or cefepime was 5.7 days (p less than 0.0001) and 4.1 days (p = 0, 0039), respectively. The use of cephalosporins indoors (p = 0.1) did not affect this indicator. In addition, the use of cefepime and vancomycin resulted in a 20% reduction in the cost of medical care (p = 0.0015) compared to the absence of antibiotic prophylaxis. One patient who received oral cefuroxime died from sepsis.

For example, the prophylactic use of cefepime or vancomycin, as well as voriconazole, results in a marked decrease in the incidence of sepsis in children with acute myeloid leukemia and a decrease in the length of hospital stay.