EVALUATION OF PENICILLIN-G IN THE PREVENTION OF STREPTOCOCCAL SEPTICEMIA IN PATIENTS WITH ACUTE MYELOID-LEUKEMIA UNDERGOING CYTOTOXIC CHEMOTHERAPY

The efficacy of penicillin G was evaluated in the prevention of infect ions caused by streptococci in patients receiving remission induction or intensive consolidation treatment for acute myeloid leukaemia. Betw een 1980 and 1988,29 episodes of streptococcal septicaemia occurred in 139 treatment events. All patients received as prophylaxis regimen ci profloxacin (n = 38) or a combination of polymyxin B with nalidixic ac id (n = 42) or neomycin (n = 59). Six patients died of streptococcal s epticaemia despite adequate antibiotic treatment. The high incidence o f streptococcal septicaemia lead to the administration of penicillin G in addition to ciprofloxacin as prophylaxis regimen during the 14 day s immediately following cytotoxic chemotherapy. Only two episodes of s treptococcal septicaemia were documented after addition of penicillin G to the prophylaxis regimen (n = 76, p < 0.001). Both patients had an uneventful recovery after treatment with vancomycin. Patients receivi ng penicillin G prophylaxis experienced fever during 17 % of the time and received antimicrobial therapy during 20 % of the time per treatme nt event compared with 27 % and 32 % respectively of this time in pati ents receiving no streptococcal prophylaxis (p < 0.001). Penicillin G prophylaxis was associated with an increased incidence of fever of unk nown origin and more frequent isolation of aerobic gram-negative bacte ria in surveillance cultures. Penicillin G in combination with ciprofl oxacin proved to be highly successful in preventing infections caused by streptococci and in reducing infection-related mortality and morbid ity.