PROPHYLACTIC ANTIBIOTICS ELIMINATE BACTEREMIA AND ALLOW SAFE OUTPATIENT MANAGEMENT FOLLOWING HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM-CELL RESCUE

This study examines the effectiveness of prophylactic ciprofloxacin an d rifampin following high-dose chemotherapy and autologous stem cell r escue (HDC/ASCR). Specific endpoints included the incidence of fever, clinically documented infection, bacteremia, and readmission rates fro m an outpatient bone marrow trans plant setting following infection or fever. A group of 97 patients receiving 134 cycles of HDC/ASCR were s tudied. Patients were given ciprofloxacin 750 mg p.o. twice daily and rifampin 300 mg p.o. twice daily beginning on the day of stem cell rei nfusion (24-48 h after completion of high-dose chemotherapy). Most pat ients were either discharged to an outpatient setting following comple tion of their chemotherapy or received all of their chemotherapy in an outpatient setting. Febrile neutropenia was treated with empirical an tibiotics in an outpatient setting unless it was complicated by hypote nsion, renal failure, severe mucositis or other problems. The median d uration of neutropenia (absolute neutrophil count below 500/mm(3)) was 7 days. Neutropenic fever occurred in 62% of patients but clinically documented bacterial infection occurred in only 2 (1.5%) patients duri ng their neutropenic period. No bacteremia was noted. Readmission to t he hospital following fever or infection occurred in 26% of patients m aintained in the outpatient setting. There were no deaths from a bacte rial infection in this study although 1 patient (0.7%) died from asper gillosis. Prophylactic ciprofloxacin and rifampin is a well-tolerated and highly effective combination that effectively decreases the risk o f both gram-positive and gram-negative bacterial infection following H DC/ASCR. It facilitates outpatient management of myelosuppressed patie nts receiving autologous stem cell rescue.