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Gram-Positive Infections and Quinolones in Neutropenia
- Elio Castagnola, MD; and
- Claudio Viscoli, MD
- G. Gaslini Children's Hospital, 16147 Genova, Italy National Institute for Cancer Research, University of Genova, Genova, Italy
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TO THE EDITOR:
In their recent report, Bow and colleagues [1] suggest that prophylaxis with fluoroquinolones and rifampin in neutropenic patients decreases the incidence of gram-negative bacteremias and the overall number of documented infections. However, prophylaxis did not reduce the number of febrile episodes or the use of intravenous antibiotics and did not affect either the final outcome of febrile episodes that occurred despite prophylaxis or the overall mortality rate. Although the statistical power of the observed results is not clear (surprisingly, the manner in which the sample size was calculated was not explained), these results deserve some comments, especially about the conclusions one should draw from this article.
We wonder whether it is worthwhile to recommend widespread use of fluoroquinolone prophylaxis, with the accompanying risk for increasing resistance [2], in the absence of any pragmatic benefit for the patient receiving this prophylaxis. Moreover, because fluoroquinolone use may be associated with the emergence of bacteria that show cross-resistance to fluoroquinolones, β-lactams, and aminoglycosides [3], we could face the risk for losing essential weapons for the treatment of febrile neutropenias. The authors themselves recognize that fluoroquinolone prophylaxis might increase the risk for infections from resistant microorganisms. A more reasonable approach might be to administer prophylaxis only to selected high-risk patients [4] or to narrow the target of prophylaxis, focusing on infections with specific pathogens [5].
In our opinion, the conclusion that should be drawn from Bow and colleagues' study is that fluoroquinolone prophylaxis with or without increased anti-gram-positive activity should not be recommended. This therapy has no pragmatic effect on the number of fevers or on the patient's final outcome and may increase antimicrobial resistance.
Elio Castagnola, MD
G. Gaslini Children's Hospital; 16147 Genova, Italy
Claudio Viscoli, MD
National Institute for Cancer Research; University of Genova; Genova, Italy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
