A Pilot Study of Antibiotic Cycling in a Hematology-Oncology Unit

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Abstract
Objective: To determine the safety and treatment efficacy of cycling antibiotic regimens for prophylaxis or treatment of patients with profound neutropenia.Design: A prospective, nonrandomized, observational trial.Setting: A 20-bed adult hematology-oncology inpatient unit at a university referral hospital.Patients: Hospitalized adult patients with chemotherapy-or radiation-induced neutropenia (absolute neutrophil count less than 500 cells/mm3).Intervention: Between July 1994 and January 1996, 295 hospitalized patients were evaluated on an intent-to-treat basis for the cycling protocol. Of these, 271 were eligible and assigned to one of four antibiotic regimens being used at the time of enrollment: (1) ceftazidime+vancomycin; (2) imipenem; (3) aztreonam+cefazolin; (4) ciprofloxacin+clindamycin. Data on infection rates and types, and antibiotic resistance patterns, toxicity, and effectiveness were collected.Results: Twenty-four patients were excluded. Of the 271 evaluable patients, 123 (42%) were able to complete treatment on the assigned regimen. Of the 148 patients (50%) unable to do so, the reasons for failure included persistent fever (79%), breakthrough bacteremia (14%), and drug toxicity (7%). The antibiotic susceptibility profiles over the study period showed no increase in resistance. However, there was a marked increase in enterococcal infections.Conclusions: Our data show no significant increase in side effects or decrease in efficacy while cycling antibiotics among neutropenic patients and thus support further study of its role.