Patients undergoing intensive antileukemic
chemotherapy and profound
granulocytopenia are susceptible to overwhelming
infections, particularly those arising from disease- and
therapy-related gastrointestinal tract damage. We have previously demonstrated that the ability to suppress bacterial colonization of this site with oral
norfloxacin prophylaxis (400 mg every 12 h) affects the incidence and distribution of aerobic
gram-negative bacterial infections and the overall management of infectious complications in this patient population. We have now determined the broad impact of continuous, long-term use of oral
norfloxacin on aerobic
gram-negative bacterial infection and colonization, overall management of presumed and documented
infections during marrow aplasia and emergence of clinically significant
antibiotic resistant pathogens during intensive antileukemic
chemotherapy. Oral
norfloxacin prophylaxis administered throughout the course of induced
granulocytopenia continues to afford effective protection by suppressing the development of aerobic gram-negative
infections, particularly those arising from the gastrointestinal tract, and preventing the acquisition or emergence of multiply resistant pathogens. A long-range effect of
norfloxacin on pathogens colonizing the respiratory tract is also detected, with inhibition of acquired drug resistance occurring at that site as well. For these reasons,
norfloxacin continues to be an excellent agent for oral prophylactic use in this patient population.