A Comparison of Trimethoprim-Sulfamethoxazole plus Nystatin with Gentamicin plus Nystatin in the Prevention of Infections in Acute Leukemia

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Abstract
Fifty-three profoundly granulocytopenic patients with relapsed acute leukemia who were undergoing reinduction chemotherapy were prospectively randomized to receive either trimethoprim–sulfamethoxazole plus nystatin or gentamicin plus nystatin for prevention of infections. The acquisition of new organisms per patient during the total study period was similar in both groups. Thirty-five symptomatic infections (five of which were bacteremias) occurred in patients receiving trimethoprim–sulfamethoxazole plus nystatin, whereas 31 infections (eight bacteremias) occurred in patients receiving gentamicin plus nystatin. Four deaths related to infection occurred in patients taking triethoprim–sulfamethoxazole, and eight occurred in patients taking gentamicin. We conclude that triethoprim–sulfamethoxazole plus nystatin was approximately as effective as gentamicin plus nystatin for prophylaxis against infection in relapsed acute leukemia. Furthermore, side effects were fewer and compliance was better with trimethoprim–sulfamethoxazole plus nystatin. (N Engl J Med. 1981; 304:1057–62.)