Memphis, TN—Initiation of chemotherapy for children with acute lymphoblastic leukemia (ALL) often leads to neutropenia, which, in turn, can increase risk of life-threatening infections that also can delay cancer treatment.

A study in Clinical Infectious Diseases notes that up to 4% of pediatric ALL patients die from treatment-related infections.

Now, however, St. Jude Children’s Research Hospital researchers have identified an antibiotic that significantly reduces the odds of infections in those children, without also increasing antibiotic resistance.

“This research provides the first major evidence supporting targeted use of antibacterial prophylaxis for at-risk pediatric ALL patients, particularly use of the broad-spectrum antibiotic levofloxacin,” explained lead author Joshua Wolf, MD, of the St. Jude Department of Infectious Diseases.

Preventive therapy with levofloxacin or other antibiotics reduced the odds of infection, including fevers and bloodstream infections, by 70% or more in ALL patients with neutropenia during induction therapy, study authors report.

Levofloxacin also reduced by 95% patients’ odds of antibiotic-associated infection with Clostridium difficile; the hospital-acquired infection increases the risk of death in children seven-fold.

At the same time, levofloxacin allowed front-line antibiotics such as vancomycin and cefepime to be held back for use if patients develop infections during therapy.

“Prophylactic antibiotic therapy with levofloxacin is routine for at-risk adult ALL patients, but it has remained controversial in children,” Wolf said. “Until this study, evidence supporting the safety and efficacy of prophylactic antibiotic therapy in children with ALL has been sparse.”

The study, conducted from 2007 to 2016, included 344 St. Jude patients enrolled in the St. Jude Total XVI clinical trial for patients newly diagnosed with ALL.

The researchers used a change in hospital policy to compare approaches. Until July 2014, patients received prophylactic antibiotic therapy at the discretion of their physicians, but after that, hospital treatment guidelines changed to recommend prophylactic levofloxacin therapy during induction therapy for ALL patients who develop neutropenia expected to last at least 7 days.

The study compared 173 patients who received no preventive antibiotics; 69 patients treated prophylactically with levofloxacin; and 102 patients who received other prophylactic antibiotics, typically cefepime, ciprofloxacin, or vancomycin, alone or in combination.

While patients with neutropenia who received any prophylactic therapy were far less likely than those who did not to develop fever, documented or likely infections, or bloodstream infections, only the levofloxacin patients also showed reduction in C. difficile infections.

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