Maschmeyer G
Ev. Krankenhaus Essen-Werden, Department of Haematology and Oncology, Germany.
Drugs. 1993;45 Suppl 3:73-80. doi: 10.2165/00003495-199300453-00014.
The prevention and treatment of infections are major issues of supportive care in patients with haematological malignancies. Because of their broad antimicrobial activity, the use of fluoroquinolones for prophylaxis in neutropenic patients has been extensively studied. In comparison with placebo, norfloxacin reduces the incidence of Gram-negative infections, whereas Gram-positive bacterial and fungal infections remain unaffected. Ofloxacin and enoxacin also bacterial and fungal infections remain unaffected. Ofloxacin and enoxacin also produce a reduction in fever and documented infections. In randomized studies comparing ciprofloxacin with cotrimoxazole (trimethoprim/sulfamethoxazole) plus colistin (each in combination with nonabsorbable antifungal agents), conflicting results were obtained. The incidence of documented Gram-negative bacterial infections was markedly reduced by ciprofloxacin prophylaxis; however, the number of Gram-positive infections may increase dramatically. Combining ciprofloxacin with a macrolide antibiotic in an attempt to prevent streptococcal infections can result in breakthrough bacteraemias due to resistant Gram-positive pathogens. Empirical antimicrobial therapy after quinolone prophylaxis should also be directed against microorganisms susceptible to quinolones, since sustained eradication by oral administration cannot be assumed with certainty. Clinical trials comparing intravenous quinolones in combination with aminoglycosides with widely used standard regimens for the treatment of infections in cancer patients indicate equivalent efficacy; however, in studies of ciprofloxacin alone, response rates were significantly lower compared with standard combinations. Therefore, quinolone monotherapy as empirical treatment in febrile neutropenic patients cannot be recommended.
感染的预防和治疗是血液系统恶性肿瘤患者支持性治疗的主要问题。由于氟喹诺酮类药物具有广泛的抗菌活性，其在中性粒细胞减少患者中用于预防的应用已得到广泛研究。与安慰剂相比，诺氟沙星可降低革兰氏阴性菌感染的发生率，而革兰氏阳性菌和真菌感染不受影响。氧氟沙星和依诺沙星对细菌和真菌感染也无影响。氧氟沙星和依诺沙星还可降低发热和确诊感染的发生率。在将环丙沙星与复方新诺明（甲氧苄啶/磺胺甲恶唑）加黏菌素（各与不可吸收的抗真菌剂联合使用）进行比较的随机研究中，得到了相互矛盾的结果。环丙沙星预防可显著降低确诊的革兰氏阴性菌感染的发生率；然而，革兰氏阳性菌感染的数量可能会急剧增加。将环丙沙星与大环内酯类抗生素联合使用以预防链球菌感染，可能会导致因耐革兰氏阳性病原体而出现突破性菌血症。喹诺酮预防后的经验性抗菌治疗也应针对对喹诺酮敏感的微生物，因为不能确定口服给药能持续根除感染。将静脉用喹诺酮与氨基糖苷类联合使用与广泛使用的治疗癌症患者感染的标准方案进行比较的临床试验表明疗效相当；然而，在单独使用环丙沙星的研究中，与标准联合用药相比，有效率显著较低。因此，不推荐将喹诺酮单药治疗作为发热性中性粒细胞减少患者的经验性治疗。
