ORAL ANTIMICROBIAL PROPHYLAXIS IN BONE-MARROW TRANSPLANT RECIPIENTS -RANDOMIZED TRIAL OF CIPROFLOXACIN VERSUS CIPROFLOXACIN-VANCOMYCIN

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.