Feng, X., Ruan, Y., He, Y., Zhang, Y., Wu, X., Liu, H., . . . Li, C. (2014). Prophylactic first-line antibiotics reduce infectious fever and shorten hospital stay during chemotherapy-induced agranulocytosis in childhood acute myeloid leukemia. Acta Haematologica, 132, 112–117.
DOI Link
Study Purpose
To study the efficacy of prophylactic antibiotics in pediatric patients with agranulocytosis and to investigate the efficacy and safety of different prophylactic protocols
Intervention Characteristics/Basic Study Process
Antibiotics included the combination of vancomycin and cefepime or single-use piperacillin/tazobactam. Control patients did not receive antibiotics prophylactically. Both groups were given oral voriconazole to prevent invasive fungal infections.
Sample Characteristics
- N = 38
- MEAN AGE: 8.3 years
- MALES: 63%, FEMALES: 37%
- KEY DISEASE CHARACTERISTICS: All had Acute myeloid leukemia (AML) and agranulocytosis after high-intensity chemotherapy
Setting
- SITE: Single-site
- SETTING TYPE: Not specified
- LOCATION: China
Phase of Care and Clinical Applications
- PHASE OF CARE: Active antitumor treatment
- APPLICATIONS: Pediatrics
Study Design
Nonrandomized, observational trial
Measurement Instruments/Methods
- Febrile events defined as a single-axillary temperature > 38.3° centigrade
- Cultures
Results
There were no differences found between the two preventive protocols used. The prophylactic group had less frequent fever (p < .001), a longer interval to fever (p = .007), and an average of seven fewer hospital days (p < .001). Pulmonary and oral infection were most common. In the prophylactic group, three patients had diarrhea and one patient developed a rash. There were no other antibiotic-related side effects.
Conclusions
There were no differences found between the two preventive protocols used. The prophylactic group had less frequent fever (p < .001), a longer interval to fever (p = .007), and an average of seven fewer hospital days (p < .001). Pulmonary and oral infection were most common. In the prophylactic group, three patients had diarrhea and one patient developed a rash. There were no other antibiotic-related side effects.
Limitations
- Small sample (< 100)
- Risk of bias (no blinding)
- Risk of bias (no random assignment)
- Measurement validity/reliability questionable
- Other limitations/explanation: The main outcome measure was a single episode of fever.
Nursing Implications
The findings showed that prophylactic antibiotics after high-intensity chemotherapy can be effective in children with minimal side effects. Findings should be considered with some caution given the study's limitations.