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Oral ciprofloxacin plus colistin: prophylaxis against bacterial infection in neutropenic patients. A strategy for the prevention of emergence of antimicrobial resistance
Author(s) -
Prentice H. Grant,
Hann Ian M.,
Nazareth Bernadette,
Paterson Pamela,
Bhamra Amrat,
Kibbler Christopher C.
Publication year - 2001
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.2001.03034.x
Subject(s) - ciprofloxacin , colistin , medicine , antibiotics , neutropenia , antimicrobial , gastroenterology , surgery , microbiology and biotechnology , chemotherapy , biology
Following a 2‐year study, the combination of oral ciprofloxacin and colistin has been used continuously for 10 years without the emergence of resistance. During a 2‐year period (1987–1989), we compared ciprofloxacin + colistin (CIP + COL) with neomycin + colistin (NEO + COL) in a randomized trial – combinations chosen because of the potential for prophylaxis of Gram‐negative infection by ciprofloxacin, with colistin given to reduce the risk of emergence of resistance. Sixty‐four patients with similar demographics in each arm were evaluable for efficacy analysis. Patients on CIP + COL had a significantly lower proportion of neutropenic days with fever ( P < 0·001) and neutropenic days on intravenous antibiotics ( P < 0·001) than patients on NEO + COL. A total of 54 (15 bacteriologically documented) pyrexial episodes occurred in patients on CIP + COL and 77 (41 bacteriologically documented) in patients on NEO + COL. Only two Gram‐negative bacterial infections occurred in the CIP + COL arm compared with 16 in the NEO + COL arm. No Staphylococcus aureus infections occurred in the CIP + COL group compared with 10 in the other patients. Two CIP‐resistant Gram‐negative bacilli were isolated from patients on CIP + COL compared with 13 NEO‐resistant Gram‐negative bacilli from patients on NEO + COL. Following a subsequent decade of unchanged use of this prophylactic strategy in neutropenic patients, a 2‐year follow‐up study between 1 January 1998 and 31 December 1999 showed 66 significant infections during 350–400 neutropenic episodes. Eight of the 111 (7·2%) isolates were with ciprofloxacin‐resistant organisms, involving 2% of the neutropenic episodes, indicating that the strategy of combining colistin with ciprofloxacin has been effective in the prevention of Gram‐negative sepsis in neutropenic patients without the emergence of significant resistance despite widespread concurrent hospital and community use of the quinolones.