Study Finds Antibiotic Effective in Reducing Rate of Infection in Children With ALL

The antibiotic Levofloxacin may be effective in reducing the rate of infection risk in children with acute lymphoblastic leukemia (ALL), according to a study from St. Jude Children's Research Hospital.

The recent study, published in Clinical Infectious Diseases, investigated the safety and efficacy of using antibiotic therapy for infection prevention in pediatric ALL patients. The study included a cohort of recently diagnosed ALL patients and compared the infection-related outcomes in those who received no prophylaxis, to those who received levofloxacin prophylaxis, or other prophylaxis during induction therapy.

“Infections remain the most frequent cause of serious treatment-related morbidity and mortality in children and adolescents with acute lymphoblastic leukemia (ALL); currently, up to 4% of children with ALL die of infection,” the authors wrote. “…Primary antibacterial prophylaxis during chemotherapy-related neutropenia in adults reduces clinically documented infection, microbiologically documented infection, and infection-related mortality.”

Of the 344 patients in the study, 173 received no prophylaxis, 69 received levofloxacin prophylaxis, and 102 received other prophylaxis regimens. Those receiving prophylaxis had longer duration of neutropenia while prophylaxis also reduced the odds of febrile neutropenia, like bacterial infection and bloodstream infection, by ≥70%. However, levofloxacin prophylaxis alone was able to reduce these infections while also reducing cephalosporin, aminoglycoside, vancomycin exposure, and Clostridium difficile infections by >95%.

“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,” said lead author Joshua Wolf, MD, an assistant member of the St. Jude Department of Infectious Diseases.

This study represented the largest to date of antibacterial prophylaxis during induction therapy for pediatric ALL patients. The study noted the need for additional studies to monitor the long-term antibiotic-resistance.

“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,” Wolf concluded.