Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Pediatric Infectious Diseases, Children's National, Washington, District of Columbia, USA.
J Pediatric Infect Dis Soc. 2024 Sep 26;13(9):486-492. doi: 10.1093/jpids/piae077.
There are conflicting recommendations on whether to use or not to use fluoroquinolone prophylaxis in pediatric oncology patients. An international pediatric clinical practice guideline (CPG) recommends administering levofloxacin prophylaxis in patients with acute myeloblastic leukemia and relapsed acute lymphoblastic leukemia receiving intensive chemotherapy as this practice has been found to reduce episodes of fever and bacteremia. A separate European CPG does not recommend levofloxacin prophylaxis because of concerns for adverse effects, including potentiation of fluoroquinolone resistance and possible increased resistance to other classes of antibiotics. The nuance of the decision to give or not give prophylaxis is discussed in the context of published evidence defining the risks and benefits of levofloxacin prophylaxis for pediatric leukemia patients at high risk for bacterial infection. Knowledge gaps are also identified to guide further investigations to optimize the use of fluoroquinolone prophylaxis in pediatric patients receiving chemotherapy for cancer or undergoing a hematopoietic cell transplantation.
对于儿科肿瘤患者是否使用氟喹诺酮类药物预防感染存在相互矛盾的建议。一项国际儿科临床实践指南（CPG）建议在接受强化化疗的急性髓细胞白血病和复发急性淋巴细胞白血病患儿中使用左氧氟沙星预防感染，因为这种做法已被证明可减少发热和菌血症的发生。另一项欧洲 CPG 不建议使用左氧氟沙星预防感染，因为担心会出现不良反应，包括增强氟喹诺酮类药物的耐药性以及可能对其他类别的抗生素产生耐药性。在权衡利弊时，需要考虑到预防使用左氧氟沙星对高细菌感染风险的儿科白血病患者的影响，这在已发表的相关证据中进行了讨论。此外，还确定了知识空白，以指导进一步的研究，从而优化氟喹诺酮类药物在接受化疗治疗癌症或进行造血细胞移植的儿科患者中的预防使用。
