Mayer, K., Hahn-Ast, C., Muckter, S., Schmitz, A., Krause, S., Felder, L., . . . von Lilienfeld-Toal, M. (2015). Comparison of antibiotic prophylaxis with cotrimoxazole/colistin (COT/COL) versus ciprofloxacin (CIP) in patients with acute myeloid leukemia. Supportive Care in Cancer, 23, 1321–1329. 

To compare efficacy and development of bacterial resistance with prophylactic antibiotic regimens of either COT/COL or CIP

Patients with acute myeloid leukemia (AML) were given antibiotic prophylaxis with either 960 mg cotrimoxazole twice daily and colistin 200 mg three times daily or 500 mg ciproloxacin twice daily. Those receiving CIP were also given cotrimoxazole twice daily two times per week for pneumocystis prophylaxis. All received antifungal prophylaxis. Colony-stimulating factors were given to some patients at the doctor's discretion. Patients receiving CIP did not receive antiviral prophylaxis. Infection-related outcomes were compared between these two cohorts. The study included patients over a four-year span of time. Environmental antimicrobial interventions were standard across both groups.

• N = 204  
• MEDIAN AGE = 62 years
• MALES: 59%, FEMALES: 41%
• KEY DISEASE CHARACTERISTICS: All had AML. The majority were receiving induction chemotherapy (61%), and 34% of chemotherapy courses were for consolidation.

• SITE: Single site  
• SETTING TYPE: Inpatient    
• LOCATION: Germany

• PHASE OF CARE: Active antitumor treatment

• Retrospective

• Fever defined at axillary temperature of at least 38º C
• Infections defined as occurrence of fever and detection of bacterial or fungal pathogens in at least one culture from sterile body sites
• Pneumonia defined as fever with infiltrates on radiological imaging
• Common Terminology Criteria for Adverse Events (CTCAE)

In both groups, the incidence of febrile neutropenia was about 80%. There were no differences between groups in infections. There were no differences between groups in detection or colonization of resistant organisms. There were no differences between groups in ICU useor differences in mortality related to underlying disease, infection, or septic shock. In both groups, infection was the major cause of death (70%). Overall, 8% of patients died. There were no differences between groups in treatment toxicity.

Both antibiotic prophylactic regimens resulted in similar patient outcomes, and both appeared to have similar efficacy.

• Risk of bias (no random assignment)

Although antibiotic prophylaxis with quinolones is generally preferred, antibiotic prophylaxis with COT/COL was essentially equally effective in this study, and might be considered an effective combination. Some studies have shown increase in quinolone-resistant organisms with standard quinolone prophylaxis. COT/COL prophylaxis may provide an alternative.