Prophylactic co-trimoxazole versus norfloxacin in neutropenic children — perspective randomized study

Abstract

Co-trimoxazole or norfloxacin were randomly administered to 44 granulocytopenic children with malignancies in order to prevent bacterial infections. Although more patients in the co-trimoxazole group had febrile episodes (pEscherichia coli (n=2),Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus sp. There were four septicemic episodes in the norfloxacin group due toP. aeruginosa, Streptococcus pneumoniae, Streptococcus mitis andStreptococcus faecalis. Compliance was good during administration of both drugs. No signs or symptoms of arthropathy were seen in the norfloxacin group. The number of gram-negative bacilli resistant to co-trimoxazole isolated from stools significantly increased during prophylaxis with co-trimoxazole (pEscherichia coli (n=2)Klebsiella pneumoniae, Pseudomonas aeruginosa undStreptococcus sp. In der Norfloxacin-Gruppe traten vier Septikämien auf, die durchP. aeruginosa, Streptococcus pneumoniae, Streptococcus mitis undStreptococcus faecalis verursacht wurden. Bei beiden Prophylaxeregimen war eine gute Compliance festzustellen. In der Norfloxacin-Gruppe waren keine Hinweise für eine Arthropathie zu finden. Unter Cotrimoxazol-Prophylaxe war eine signifikante Zunahme von gramnegativen Stuhlisolaten mit Resistenz gegen Co-trimoxazol festzustellen (p<0,001). Bei Norfloxacin war dagegen keine Selektion resistenter Stämme festzustellen, gramnegative Stäbchenbakterien wurden sehr effizient aus dem Stuhl eliminiert (27,5% der positiven Kulturen).