Boztug, H., Muhlegger, N., Potschger, U., Attarbaschi, A., Peters, C., Mann, G., & Dworzak, M. (2017). Antibiotic prophylaxis with teicoplanin on alternate days reduces rate of viridans sepsis and febrile neutropenia in pediatric patients with acute myeloid leukemia. Annals of Hematology, 96, 99–106. 

Report results from using prophylactic outpatient use of teicoplanin or vancomycin for hospitalized patients on febrile neutropenia and bacterial sepsis for cases from 2005–2015. Prior to 2008, no routine antibiotic prophylaxis was used and antibiotics for prophylaxis when used varied. In 2009, a regimen with teicoplanin 15–20 mg/kg IV was instituted, starting at the onset of severe neutropenia on alternate days until the absolute neutrophil count was more than 400/mcl. In hospitalized cases, vancomycin was used. All patients received Pneumocystis jirovecii and systemic antifungal prophylaxis. Colony-stimulating factors were not used.

Data were collected from retrospective chart review for the use of antibiotics and the incidence and severity of infection.

• N = 50   
• AGE: Not provided
• MALES: Not provided  
• FEMALES: Not provided
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had acute myeloid leukemia. Cases of relapse after hematopoietic cell transplantation were not included.

• SITE: Single site   
• SETTING TYPE: Multiple settings    
• LOCATION: Vienna

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Retrospective cohort comparison

• Febrile neutropenia defined as a temperature greater than 38 degrees C with neutropenia that lasted for an hour, or a single temperature of at least 38.5.
• Bacterial blood cultures were obtained for patients with fever or other signs of infection.

In 98 chemotherapy cycles with teicoplanin or vancomycin prophylaxis, no patients developed viridians sepsis compared to 12 cases of viridians sepsis in patients without prophylaxis (p < 0.0001). Episodes of febrile neutropenia were also fewer in the teicoplanin/vancomycin group (44% versus 82%, p < 0.0001). No appreciable rise in vancomycin-resistant enterococci (VRE) incidence was observed since the regimen had begun.

The findings showed improved outcomes with antibiotic prophylaxis and no apparent rise in VRE isolates with the use of teicoplanin/vancomycin for prophylaxis.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Key sample group differences that could influence results
• The efficacy of the regimen studies was compared to no prophylaxis.
• There were few cases in which different antibiotics were used.

The findings provide support for the benefit of antibiotic prophylaxis in general. Additional research is needed to determine the effects of routine vancomcin/teicoplanin use on the emergence of resistant organisms. Although no such increase was observed in this study, it has been identified in others.