Przybylski Daniel J, Reeves David J
College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.
Department of Pharmacy, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA.
Support Care Cancer. 2017 Dec;25(12):3715-3721. doi: 10.1007/s00520-017-3797-2. Epub 2017 Jun 28.
Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. There is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting.
A retrospective chart review was completed comparing the use of prophylactic moxifloxacin to that of levofloxacin or ciprofloxacin during periods of prolonged neutropenia. Adult patients admitted to a community teaching hospital while receiving induction or reinduction chemotherapy for acute myeloid leukemia were included.
One hundred and forty-one patients were included in this study. The two groups displayed slight heterogeneity: patients receiving moxifloxacin were approximately 10 years younger (54 vs. 64 years, p = 0.01), more likely to receive granulocyte colony stimulating factor (GCSF) (45 vs. 19%, p = 0.001), and neutropenic for a longer duration (23 vs. 19 days, p = 0.009). The incidence of febrile neutropenia (76 vs. 81%, RR 0.93, 95% CI 0.78-1.11, p = 0.42) and of documented infections (27 vs. 33%, RR 0.82, 95% CI 0.49-1.36, p = 0.44) was similar between those receiving moxifloxacin and levofloxacin/ciprofloxacin, respectively. Hospital readmission for an infectious issue within 30 days of hospital discharge (9 vs. 5%, p = 0.39) was also similar between groups as was the incidence of Clostridium difficile (9 vs. 9%, p = 0.96).
Moxifloxacin may be an alternative to levofloxacin or ciprofloxacin in patients with a prolonged risk of febrile neutropenia requiring prophylaxis.
接受强化化疗方案的患者因长期中性粒细胞减少和住院时间延长而发生感染并发症的风险很高。氟喹诺酮类抗生素，主要是左氧氟沙星和环丙沙星，是这些患者预防性治疗的主要药物。关于包括莫西沙星在内的其他喹诺酮类抗生素在这种情况下的使用数据有限。
完成一项回顾性病历审查，比较在长期中性粒细胞减少期间预防性使用莫西沙星与左氧氟沙星或环丙沙星的情况。纳入在社区教学医院接受急性髓系白血病诱导或再诱导化疗的成年患者。
本研究纳入了141名患者。两组显示出轻微的异质性：接受莫西沙星治疗的患者年龄约小10岁（54岁对64岁，p = 0.01），更有可能接受粒细胞集落刺激因子（GCSF）（45%对19%，p = 0.001），中性粒细胞减少持续时间更长（23天对19天，p = 0.009）。接受莫西沙星和左氧氟沙星/环丙沙星治疗的患者中，发热性中性粒细胞减少的发生率（76%对81%，RR 0.93，95%CI 0.78 - 1.11，p = 0.42）和有记录的感染发生率（27%对33%，RR 0.82，95%CI 0.49 - 1.36，p = 0.44）相似。出院后30天内因感染问题再次入院的情况（9%对5%，p = 0.39）在两组之间也相似，艰难梭菌感染的发生率（9%对9%，p = 0.96）也是如此。
对于有长期发热性中性粒细胞减少风险需要预防的患者，莫西沙星可能是左氧氟沙星或环丙沙星的替代药物。
