July 28, 2008

Prophylactic Use of Specific Antibiotics Reduce the Risk of Some Infections in AML


Prophylactic Use of Specific Antibiotics Reduce the Risk of Some Infections in AML

Specific antibiotics used during remission (no evidence of disease) following induction therapy reduce the risk of some types of infection and associated complications among pediatric patients with acute myeloid leukemia. These results were published in an early on-line version?in the journal Cancer.

Acute myeloid leukemia (AML) is a cancer of the bone marrow and blood characterized by the rapid, uncontrolled growth of immature white blood cells known as myelocytes. The disease is more common in adults than in children; average age at diagnosis is more than 65 years.

Treatment of AML often begins with induction therapy (initial treatment) that includes chemotherapy to produce a complete remission (defined as the disappearance of leukemia cells in the bone marrow and normalization of the white blood cell, red blood cell, and platelet levels). After induction therapy, patients generally receive additional treatment (consolidation therapy) to reduce the likelihood of leukemia recurrence. Depending upon prognosis, age of the patient, and/or other existing medical conditions, consolidation therapy can range from extremely aggressive to less aggressive.

Since treatment for AML is associated with killing immune cells, patients become susceptible to infection, which may become life-threatening. Therefore, researchers may use antibiotics to prevent infection among these patients. However, there remains the concern of over-utilizing antibiotics and creating organisms that are resistant to antibiotic therapy.? Research continues to explore the most effective and efficient ways in which to effectively prevent infection without creating resistant strains of infection-causing microorganisms.

Researchers from St. Jude Children?s Research Hospital recently conducted a clinical trial to explore the effectiveness of different intravenous antibiotics as prevention of infection among children with AML who were in remission following induction therapy. This trial included 78 pediatric patients who were treated between 2002 and 2007. All patients were treated with coriconazole to prevent fungal infections. Patients were then treated with either no antibiotic prophylaxis, prophylaxis with an oral cephalosporin, prophylaxis with intravenous cefepime, or a combination of vancomycin and oral ciprofloxacin or a cephalosporin.

??Oral cephalosporin alone did not reduce the incidence of bacterial sepsis (infection that has spread to the blood or other tissues) with no prophylaxis. Cephalosporin did not decrease hospitalization time.
??Intravenous cefepime completely prevented sepsis with the bacteria S viridans and reduced the incidence of bacterial sepsis by 91%. This regimen decreased hospitalization by 4.1 days compared with no prophylaxis.
??Vancomycin with oral ciprofloxacin or a cephalosporin reduced bacterial sepsis by 93% compared with no prophylaxis. This regimen decreased hospitalization by 5.7 days compared with no prophylaxis.
??Antibiotic prophylaxis did not influence the incidence of fungal infections.
??Cefepime or vancomycin prophylaxis was associated with a 20% reduction in healthcare charges.

The researchers concluded that ?prophylaxis with intravenous cefepime or a vancomycin regimen and voriconazole reduced morbidity in children with AML and resulted in dramatic decreases in the incidence of septicemia and hospitalization days.? Individuals whose children are diagnosed with AML may wish to speak with their physician regarding their child?s individual risks and benefits of preventing infection with prophylactic measures.

Reference: Kurt B, Flynn P, Shenep JL, et al. Prophylactic antibiotics reduce morbidity due to septicemia during intensive treatment for pediatric acute myeloid leukemia. Cancer [early online publication]. May 5, 2008.

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Tags: Acute Myeloid Leukemia, Uncategorized