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• W2040378007 abstract "Background: Bacterial infections are frequent complications of the postengraftment phase after ablative allogeneic HSCT. This pilot study investigated the safety and tolerability of administering antibiotic (ABX) prophylaxis from when patients tolerated PO medications after engraftment (ANC> 1500/mm3 for 2 days) through day +100. Methods: Twenty-three engrafted allogeneic BMT patients at OHSU, received moxifloxacin (MOXI) 400 mg po daily. Drug was started on discontinuation of any ABX used for the treatment of pre-enrollment bacterial infection or neutropenic fever. Rates of bacterial infection, bacteremia, and colonization were recorded. Comparisons were made with a cohort of 60 consecutive patients undergoing ablative BMT at OHSU without ABX prophylaxis from 2001 to 2002. Results: The median duration of MOXI prophylaxis was 77 days (range, 7–87 days). Five patients had dose interruptions, 4 due to nausea associated with GVHD, and 1 patient withdrew from the study. Three patients had dose interruptions during empiric ABX therapy for possible bacterial infection. Overall, MOXI was well tolerated in this patient population, with 5 episodes of grade 3/4 toxicity possibly related to study drug (2 orthostatic hypotension in 1 patient, 2 nausea, and 1 hypertension). Five patients had episodes of transaminitis that were unlikely to be due to the study medication and that responded to discontinuation of azole antifungal therapy (4) or to treatment of liver GVHD (1). No cardiac arrhythmias were observed. Compared with historic controls, a marked decrease in postengraftment bacterial infections was observed. In the control cohort, 16 patients experienced 17 episodes of Gram-negative infections and 22 patients had 25 episodes of symptomatic Gram-positive infections during the postengraftment phase without prophylaxis. In contrast with MOXI prophylaxis, 2 patients experienced 3 Gram-negative infections (χ2 test, P= .079), 1 patient had an anaerobic infection, and 7 patients had 9 symptomatic Gram-positive infections. Two breakthrough bacteremias with Streptococcus viridans occurred and were treated successfully. ABX MICs of Gram-negative isolates showed P. putida sensitive to MOXI and C. freundii resistant, both without drug efflux. Conclusions: Prophylactic MOXI dosed throughout the postengraftment phase has been well tolerated, safe, and associated with fewer bacterial infections compared to historic controls. The efficacy of this prophylaxis strategy will be determined in a planned randomized, placebo-controlled trial." @default.
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• W2040378007 date "2005-02-01" @default.
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• W2040378007 title "Safety and tolerability of antibacterial prophylaxis during the postengraftment phase after myeloablative hematopoietic stem cell transplantation" @default.
• W2040378007 doi "https://doi.org/10.1016/j.bbmt.2004.12.056" @default.
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