Skip to main content Accessibility help
×
Home

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

  • Edward A. Dominguez (a1), Theresa L. Smith (a1), Elizabeth Reed (a2), Christine C. Sanders (a3) and W. Eugene Sanders (a3)...

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.

Copyright

Corresponding author

985400 Nebraska Medical Center, Omaha, NE 68198-5400

References

Hide All
1.Shlaes, D, Levy, S, Archer, G. Antimicrobial resistance: new directions. American Society of Microbiology News 1991;57:455458.
2.Shlaes, DM, Gerding, DN, John, JF Jr, Craig, WA, Bornstein, DL, Duncan, RA, et al. Society of Healthcare Epidemiology of America and Infectious Disease Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275291.
3.Dominguez, EA, Davis, JC, Langnas, AN, Wmfield, B, Cavalieri, SJ, Rupp, ME. An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients. Liver Transpl Surg 1997;3:586590.
4.Cavalieri, SJ, Hotstetter, MK, Rupp, ME, Dominguez, EA. Synergy studies on and therapy for multiply antibiotic resistant Enterococcus faecium from a recent outbreak Presented at the 32nd Annual Meeting of the Infectious Diseases Society of America; Orlando, Florida; October 8, 1994. Abstract 179.
5.McGowan, JE Jr. Minimizing antimicrobial resistance in hospital bacteria: can switching or cycling drugs help? Infect Control 1986;7:573576.
6.Gerding, DN, Larson, TA, Hughes, RA, Wiler, M, Shanholtzer, C, Peterson, LR. Aminoglycoside resistance and aminoglycoside usage: ten years of experience in one hospital. Antimicrob Agents Chemother 1991;35:12841290.
7.King, JW, White, MC, Todd, JR, Conrad, SAAlterations in the microbial flora and in the incidence of bacteremia at a university hospital after adoption of amikacin as the sole formulary aminoglycoside. Clin Infect Dis 1992;14:908915.
8.Kollef, MH, Vlasnik, J, Sharpless, L, Pasque, C, Murphy, D, Fraser, V. Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 1997;156:10401048.
9.Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353358.
10.Sanders, WE, Sanders, CC. Cycling of antibiotics: an approach to circumvent resistance in specialized units of the hospital. Clin Microbiol Infect 1996;1:223225.
11.Hughes, WT, Armstrong, D, Bodey, GP, Feld, R, Mandeli, GL, Meyers, JD, et al. From the Infectious Diseases Society of America. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 1990;161:381396.
12.Rahmpal, R. Is monotherapy for febrile neutropenia still a viable alternative? Clin Infect Dis 1999;29:508514.
13.Engels, EA, Ellis, CA, Supran, SE, Schmid, CH, Barza, M, Schenken, DP, et al. Early infection in bone marrow transplantation: quantitative study of clinical factors that affect risk. Clin Infect Dis 1999;28:256266.
14.Heizmann, WR. Circumventing antibiotic resistance in specialized hospital units. Clin Microbiol Infect 1997;3:133134.
15.Schentag, JJ. The results of a targeted pharmacy intervention program. Clin Ther 1993;15(suppl A):2936.
16.John, JF Jr, Rice, LB. The microbial genetics of antibiotic cycling. Infect Control Hosp Epidemiol 2000;21(suppl):S22S31.
17.McGowan, JE Jr, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297311.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed