Evaluating an antibiotic switch

Vaccine and Infectious Disease Division

Evaluating an antibiotic switch

Patients undergoing donor bone marrow transplants, or allogeneic hematopoietic cell transplants (HCTs), are at significant risk for death or illness from bacterial infection following the transplant. To avoid complications from bacterial infection, transplant patients are often given antibiotics as a prophylactic treatment. In 2002, the Fred Hutchinson Cancer Research Center switched the type of antibiotic used for this purpose from ceftazidime to levofloxacin, as levofloxacin has a broader range of bacterial targets.

To ensure that this change in therapy was the correct decision, Center and University of Washington scientists led by VIDI member Dr. David Fredricks looked at HCT patients who received one or the other treatment at the Center from 2000-2002 (ceftazidime) and 2002-2005 (levofloxacin). They found that overall, patients receiving levofloxacin were more likely to have a fever following transplant, but this was did not mean the patients fared worse. On the contrary, the group who received levofloxacin had lower levels of bacterial infection.  As an added bonus, this drug is cheaper than ceftazidime.

Some critics of levofloxacin worried that it may cause more antibiotic resistant bacterial infections, but the scientists found no difference in resistance between the two groups of patients, suggesting that the switch in 2002 was a good choice, though continued surveillance is warranted.

The impact of a change in antibacterial prophylaxis from ceftazidime to levofloxacin in allogeneic hematopoietic cell transplantation.  Guthrie KA, Yong M, Frieze D, Corey L, Fredricks DN.  Bone Marrow Transplant. 2009 Aug 31.