Ciprofloxacin vs. levofloxacin for prophylaxis in recipients of hematopoietic stem cell transplantation

Abstract

Background Infection is the most common cause of morbidity and mortality in patients undergoing myleosuppressive therapy with the risk of infection being heightened during the neutropenic phase. Fluoroquinolones are most often utilized as prophylaxis, specifically levofloxacin or ciprofloxacin; however, there is increasing resistance among these agents. The objective of this study is to compare the efficacy of ciprofloxacin and levofloxacin when used prophylactically in hematopoietic stem cell transplantation patients. Study design A retrospective cohort study conducted at a 443-bed tertiary teaching county hospital from 1 January 2005 to 31 September 2016. Methods Patients aged 18–89 who were admitted and received levofloxacin or ciprofloxacin post hematopoietic stem cell transplantation were evaluated. Results The patient population (N = 151) was predominantly male (93 vs. 58) and the median (IQR) age was 57 (20.1) years. There were 108 patients undergoing autologous hematopoietic stem cell transplantation compared to 43 undergoing allogenic hematopoietic stem cell transplantation. Significantly fewer patients who received levofloxacin (11/43, 25.6%) developed neutropenic fever compared to patients who received ciprofloxacin (61/108, 56.5%, p = 0.0006). Also there were significantly more positive blood cultures in the ciprofloxacin group (36/108, 33.3%) compared to the levofloxacin group (4/43, 9.3%); the majority of which were Gram-positive organisms (p = 0.0025). Conclusion Prophylaxis with levofloxacin was associated with a lower incidence of febrile neutropenia and bacteremia when compared to ciprofloxacin in hematopoietic stem cell transplantation patients.