Cd. Ford et al., ORAL ANTIMICROBIAL PROPHYLAXIS IN BONE-MARROW TRANSPLANT RECIPIENTS -RANDOMIZED TRIAL OF CIPROFLOXACIN VERSUS CIPROFLOXACIN-VANCOMYCIN, Antimicrobial agents and chemotherapy, 42(6), 1998, pp. 1402-1405
The optimal oral antimicrobial prophylactic regimen for bone marrow tr
ansplant recipients remains to be elucidated. We randomized 84 patient
s to receive either oral ciprofloxacin or ciprofloxacin plus vancomyci
n at hospital admission. Patients were monitored for bacteremias and c
linical parameters, and stool and throat swab surveillance cultures we
re performed. The addition of vancomycin resulted in a significant dec
rease in the frequency of patients with surveillance cultures positive
for coagulase-negative staphylococci (stool cultures, 44 versus 23%;
throat swab cultures, 37 versus 19%) and alpha-hemolytic streptococci
(throat swab cultures, 90 versus 60%). The frequencies of positivity f
or Candida spp. and gram-negative organisms on surveillance cultures w
ere comparable. Despite these results, no differences in the incidence
s of bacteremias (12 of 41 versus 12 of 43 patients) or clinical param
eters such as number of days to first fever, total number of febrile d
ays, length of stay, and number of transfusions could be demonstrated.
Because of a lack of efficacy of vancomycin and emerging problems wit
h vancomycin-resistant isolates, vancomycin should not be used in oral
antimicrobial prophylaxis regimens.