QUINOLONE PROPHYLAXIS IN NEUTROPENIC PATIENTS - EFFICACY VERSUS RESISTANCE

To assess the efficacy of quinolones in the prophylaxis of infections in neutropenic patients with acute non-lymphocytic leukemia, and to ev aluate the emergence of quinolone resistance in two University Hospita ls in Brazil, we retrospectively compared 101 consecutive episodes of neutropenia managed with quinolone prophylaxis between 1989 and Novemb er 1993, and 26 previous episodes without prophylaxis, and reviewed th e results of in vitro sensitivity of Gram-negative strains to quinolon es in the same period. Prophylaxis with quinolones resulted in less ep isodes of bacteremias (21% vs. 69%, p=10(-7)), including Gram-negative bacteremias (6% vs. 38%, p=10(-5)), with no statistically significant difference in the death rate (18% vs. 31%, p=0.14, 95% confidence int erval -6-32). The resistance of Gramnegative strains to quinolones ros e from 7% to 18% between 1990 and 1993 (p=10(-5)). The resistance agai nst ceftazidime and amikacin, the agents used in the empirical antibio tic therapy, increased in the same proportion as the quinolones. Given the limited benefit of quinolones as prophylaxis and the increasing n umber of quinolone-resistant Gram-negative strains observed in our hos pitals, the use of quinolones as prophylaxis must be seriously questio ned. A stricter control of the use of quinolones in these hospitals mi ght decrease resistance.