Goorin A M, Hershey B J, Levin M J, Siber G R, Gelber R D, Flynn K, Lew M, Beckett K, Blanding P, Sallan S E
Pediatr Infect Dis. 1985 May-Jun;4(3):265-9. doi: 10.1097/00006454-198505000-00012.
We assessed the efficacy of prophylactic antibiotics in children receiving intensive chemotherapy for acute lymphoblastic leukemia. The patients were randomized to receive either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo in a double-blind trial. Thirty patients were evaluated in each group. Children receiving TMP-SMX had fewer episodes of bacteremia (0 vs. 5) and otitis media (3 vs. 18). The geometric mean of the neutrophil nadir was 172 in the TMP-SMX group and 287 in controls. However, no increased delay or dose reduction of chemotherapy was observed in the TMP-SMX treated patients. Five patients who received TMP-SMX developed Gram-negative rods resistant to TMP-SMX on surveillance stool cultures. We conclude that TMP-SMX prophylaxis decreased certain bacterial infections in children with acute lymphoblastic leukemia without causing clinically significant toxicity. The emergence of Gram-negative rods resistant to TMP-SMX in treated patients suggests that TMP-SMX prophylaxis should be restricted to patients who are at high risk for developing a bacterial infection or Pneumocystis carinii pneumonia.
我们评估了预防性使用抗生素对接受强化化疗的急性淋巴细胞白血病患儿的疗效。在一项双盲试验中，将患者随机分为接受甲氧苄啶-磺胺甲恶唑（TMP-SMX）或安慰剂治疗两组。每组评估30例患者。接受TMP-SMX治疗的儿童菌血症发作次数较少（0次对5次），中耳炎发作次数也较少（3次对18次）。TMP-SMX组中性粒细胞最低点的几何平均值为172，对照组为287。然而，在接受TMP-SMX治疗的患者中，未观察到化疗延迟增加或剂量减少。5例接受TMP-SMX治疗的患者在监测粪便培养时出现了对TMP-SMX耐药的革兰氏阴性杆菌。我们得出结论，预防性使用TMP-SMX可减少急性淋巴细胞白血病患儿的某些细菌感染，且不会引起具有临床意义的毒性。接受治疗的患者中出现对TMP-SMX耐药的革兰氏阴性杆菌表明，预防性使用TMP-SMX应仅限于发生细菌感染或卡氏肺孢子虫肺炎风险较高的患者。
