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Ciprofloxacin Reduces Occurrence of Fever in Children With Acute Leukemia who Develop Neutropenia During Chemotherapy

Laoprasopwattana, Kamolwish MD*; Khwanna, Thida MD*; Suwankeeree, Pussayaban MD*; Sujjanunt, Tipwan MD*; Tunyapanit, Wanutsanun MSc*; Chelae, Sureerat

Pediatric Infectious Disease Journal: March 2013 - Volume 32 - Issue 3 - p e94–e98
doi: 10.1097/INF.0b013e3182793610
Original Studies

Background: Fluoroquinolones reduce occurrence of fever in adult cancer patients who develop neutropenia, but there has been no randomized controlled trial in children, and there are only a few studies considering resistance in intestinal floral after ciprofloxacin has been used.

Methods: Children younger than 18 years with acute lymphoblastic leukemia or lymphoma scheduled to undergo chemotherapy were randomized to receive oral ciprofloxacin 20mg/kg/day or placebo from the beginning of their chemotherapy. Rectal swab cultures were taken before and at 1 and/or 2 weeks after the intervention.

Results: Of the total of 95 patients, 45 and 50 patients received ciprofloxacin and placebo, respectively. Of the 71 patients who developed neutropenia, the proportion of children who developed fever was significantly lower in the ciprofloxacin group than in the placebo group (17/34 [50.0%] versus 27/37 [73.0%]; absolute difference in risk, –23.0%; 95% confidence interval: –45.0% to –0.9%; P = 0.046). Ciprofloxacin significantly reduced the occurrence of febrile episodes in patients with acute lymphoblastic leukemia in the induction phase of chemotherapy, but not in patients with lymphoma or in the consolidation phase of chemotherapy. Adverse effects were not different between the groups. After intervention, the percentages of Escherichia coli and Klebsiella pneumoniae susceptible to ciprofloxacin were significantly lower in the ciprofloxacin group.

Conclusion: Ciprofloxacin can prevent fever in neutropenic patients with acute lymphoblastic leukemia during the induction phase of chemotherapy with good tolerance and no serious side effects. Due to the selective pressure of intestinal flora resistance to ciprofloxacin, the long-term effectiveness needs further investigation.

From the Departments of *Pediatrics and Pathology, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.

Accepted for publication 27, 2012.

All authors have made a significant contribution and have read and approved the final draft. This research was supported in part by grant no. 50-316-003-1 from the Faculty of Medicine, Prince of Songkla University. K.L. wrote the original article, with no honorarium, grant or other form of payment given to anyone to produce or help produce the article. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Kamolwish Laoprasopwattana, MD, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla 90110, Thailand. E-mail: kamolwish@gmail.com; lkamolwi@medicine.psu.ac.th

© 2013 Lippincott Williams & Wilkins, Inc.