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. 1993;12(10):750–755. doi: 10.1007/BF02098462

Evaluation of penicillin G in the prevention of streptococcal septicaemia in patients with acute myeloid leukaemia undergoing cytotoxic chemotherapy

P de Jong 1, M de Jong 2, E Kuijper 3, J van der Lelie 1,2,✉
PMCID: PMC7101765  PMID: 8307043

Abstract

The efficacy of penicillin G was evaluated in the prevention of infections caused by streptococci in patients receiving remission induction or intensive consolidation treatment for acute myeloid leukaemia. Between 1980 and 1988, 29 episodes of streptococcal septicaemia occurred in 139 treatment events. All patients received as prophylaxis regimen ciprofloxacin (n=38) or a combination of polymyxin B with nalidixic acid (n=42) or neomycin (n=59). Six patients died of streptococcal septicaemia despite adequate antibiotic treatment. The high incidence of streptococcal septicaemia lead to the administration of penicillin G in addition to ciprofloxacin as prophylaxis regimen during the 14 days immediately following cytotoxic chemotherapy. Only two episodes of streptococcal septicaemia were documented after addition of penicillin G to the prophylaxis regimen (n=76, p<0.001). Both patients had an uneventful recovery after treatment with vancomycin. Patients receiving penicillin G prophylaxis experienced fever during 17 % of the time and received antimicrobial therapy during 20 % of the time per treatment event compared with 27 % and 32 % respectively of this time in patients receiving no streptococcal prophylaxis (p<0.001). Penicillin G prophylaxis was associated with an increased incidence of fever of unknown origin and more frequent isolation of aerobic gram-negative bacteria in surveillance cultures. Penicillin G in combination with ciprofloxacin proved to be highly successful in preventing infections caused by streptococci and in reducing infection-related mortality and morbidity.

Keywords: Vancomycin, Acute Myeloid Leukaemia, Nalidixic Acid, Cytotoxic Chemotherapy, Polymyxin

References

  • 1.Cohen J, Worsley AM, Goldman JM, Donnelly JP, Catovsky D, Galton DAG. Septicaemia caused by viridans streptocci in neutropenic patients with leukaemia. Lancet. 1983;ii:1452–1454. doi: 10.1016/s0140-6736(83)90799-7. [DOI] [PubMed] [Google Scholar]
  • 2.Kern W, Kurrle E, Vanek E. High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia. Klinische Wochenschrift. 1987;65:773–780. doi: 10.1007/BF01743253. [DOI] [PubMed] [Google Scholar]
  • 3.Menichetti F, Del Favero A, Guerciolini R, Tonato M, Frongillo RF, Roila F, Pauluzzi S. Viridans streptococci septicemia in cancer patients: a clinical study. European Journal of Epidemiology. 1987;3:316–318. doi: 10.1007/BF00149743. [DOI] [PubMed] [Google Scholar]
  • 4.Van der Lelie H, van Ketel RJ, von dem Borne AEGK, van Oers RHJ, Thomas BLM, Goudsmit R. Incidence and clinical epidemiology of streptococcal septicemia during treatment of acute myeloid leukemia. Scandinavian Journal of Infectious Diseases. 1991;23:163–168. doi: 10.3109/00365549109023395. [DOI] [PubMed] [Google Scholar]
  • 5.Dybedal I, Lamvik J. Respiratory insufficiency in acute leukemia following treatment with cytosine arabinoside and septicemia withStreptococcus viridans. European Journal of Haematology. 1989;42:405–406. [PubMed] [Google Scholar]
  • 6.Kern W, Kurrle E, Schmeiser T. Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases. Infection. 1990;18:138–145. doi: 10.1007/BF01642101. [DOI] [PubMed] [Google Scholar]
  • 7.McWhinney PHM, Gillespie SH, Kibbler CC, Hoffbrand AV, Prentice HG. Streptococcus mitis and ARDS in neutropenic patients. Lancet. 1991;337:429–429. doi: 10.1016/0140-6736(91)91205-9. [DOI] [PubMed] [Google Scholar]
  • 8.Arning M, Gehrt A, Aul C, Runde V, Hadding U, Schneider W. Septicemia due toStreptococcus mitis in neutropenic patients with acute leukemia. Blut. 1990;61:364–368. doi: 10.1007/BF01738551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Henslee J, Bostrom B, Weisdorf D, Ramsay N, McGlave P, Kersey J. Streptococcal sepsis in bone marrow transplant patients. Lancet. 1984;i:393–393. doi: 10.1016/s0140-6736(84)90440-9. [DOI] [PubMed] [Google Scholar]
  • 10.Classen DC, Burke JP, Ford CD, Evershed S, Aloia MR, Wilfahrt JK, Elliott JA. Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis. American Journal of Medicine. 1990;89:441–446. doi: 10.1016/0002-9343(90)90373-l. [DOI] [PubMed] [Google Scholar]
  • 11.Rozenberg-Arska M, Dekker A, Verdonck L, Verhoef J. Prevention of bacteremia caused by alpha-hemolytic streptococci by roxithromycin (RU-28965) in granulocytopenic patients receiving ciprofloxacin. Infection. 1989;17:240–244. doi: 10.1007/BF01639528. [DOI] [PubMed] [Google Scholar]
  • 12.Guiot HFL, Peters WG, van den Broek PJ, van der Meer JWM, Kramps JA, Willemze R, van Furth R. Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin. Infection. 1990;18:131–137. doi: 10.1007/BF01642100. [DOI] [PubMed] [Google Scholar]
  • 13.Karp JE, Dick JD, Angelopulos C, Charache P, Green L, Burke PJ, Saral R. Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Randomized, double-blind, placebo-controlled clinical trial in patients with acute leukemia. American Journal of Medicin. 1986;81:237–242. doi: 10.1016/0002-9343(86)90257-3. [DOI] [PubMed] [Google Scholar]
  • 14.Heimdahl A, Mattsson T, Dahllöf G, Lönnquist B, Ringden O. The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. Oral Surgery, Oral Medicine, Oral Pathology. 1989;68:711–716. doi: 10.1016/0030-4220(89)90160-6. [DOI] [PubMed] [Google Scholar]
  • 15.Wade JC, Schimpff SC, Newman KA, Wiernik PH. Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Annals of Internal Medicine. 1982;97:503–508. doi: 10.7326/0003-4819-97-4-503. [DOI] [PubMed] [Google Scholar]
  • 16.Rubin M, Hathorn JW, Marshall D, Gress J, Steinberg SM, Pizzo PA. Gram-positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Annals of Internal Medicine. 1988;108:30–35. doi: 10.7326/0003-4819-108-1-30. [DOI] [PubMed] [Google Scholar]
  • 17.Guiot HFL, van der Meer JWM, van den Broek PJ, Willemze R, van Furth R. Prevention of viridans-group streptococccal septicemia in oncohematologic patients: a controlled comparative study on the effect of penicillin G and cotrimoxazole. Annals of Hematology. 1992;64:260–265. doi: 10.1007/BF01695467. [DOI] [PubMed] [Google Scholar]
  • 18.Santini C, Venditti M, Baiocchi P, Brandimarte C, Serra P, Mandelli F, Girmenia C, Micozzi A, Martino P. Emergence of penicillin-resistant viridans streptococci causing septicemia in granulocytopenic patients. European Journal of Epidemiology. 1988;4:391–392. doi: 10.1007/BF00148932. [DOI] [PubMed] [Google Scholar]
  • 19.Van de Leur JJJPM, Dofferhoff ASM, van Turnhout JM, Vollaard JE, Clasener HAL. Colonisation of oropharynx with staphylococci after penicillin in neutropenic patients. Lancet. 1992;340:861–862. doi: 10.1016/0140-6736(92)92747-4. [DOI] [PubMed] [Google Scholar]

Articles from European Journal of Clinical Microbiology & Infectious Diseases are provided here courtesy of Nature Publishing Group

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