BENEFIT OF PROPHYLAXIS BY INTRAVENOUS SYSTEMIC VANCOMYCIN IN GRANULOCYTOPENIC PATIENTS - A PROSPECTIVE, RANDOMIZED TRIAL AMONG 59 PATIENTS

We have tested the benefit of prophylaxis by intravenous systemic vanc omycin among 59 neutropenic patients in a randomized trial. Vancomycin was delivered on day zero of chemotherapy until the resolution of neu tropenia in the prophylactic group (vanco+). Empiric antibiotic therap y (piperacillin, ofloxacine) was identical for all patients. The numbe r of days with fever > 38.5 degrees C was significantly higher in the control (vanco-) group than in the vanco+ group (7.4 vs. 3.7, p < 0.02 ). Zero gram-positive infections occurred in the vanco+ group versus 9 in the vanco- group (p < 0.002). The mean number of days of empiric a ntibiotic therapy was reduced in the vanco+ group (11.3 vs. 16.3, p = 0.12). However, no benefit was noted between the two groups with regar d to mortality or the severity of the infections. The selection of res istant microorganisms after systemic treatment with vancomycin is of p otential risk. Such a prophylactic antibiotic regimen does not seem to be justified.