This study examines the effectiveness of prophylactic
ciprofloxacin and
rifampin following high-dose
chemotherapy and autologous stem cell rescue (HDC/ ASCR). Specific endpoints included the incidence of
fever, clinically documented
infection,
bacteremia, and readmission rates from an outpatient bone marrow transplant setting following
infection or
fever. A group of 97 patients receiving 134 cycles of HDC/ASCR were studied. Patients were given
ciprofloxacin 750 mg p.o. twice daily and
rifampin 300 mg p.o. twice daily beginning on the day of stem cell reinfusion (24-48 h after completion of high-dose
chemotherapy). Most patients were either discharged to an outpatient setting following completion of their
chemotherapy or received all of their
chemotherapy in an outpatient setting.
Febrile neutropenia was treated with empirical
antibiotics in an outpatient setting unless it was complicated by
hypotension,
renal failure, severe
mucositis or other problems. The median duration of
neutropenia (absolute neutrophil count below 500/mm3) was 7 days. Neutropenic
fever occurred in 62% of patients but clinically documented
bacterial infection occurred in only 2 (1.5%) patients during their neutropenic period. No
bacteremia was noted. Readmission to the hospital following
fever or
infection occurred in 26% of patients maintained in the outpatient setting. There were no deaths from a
bacterial infection in this study although 1 patient (0.7%) died from
aspergillosis. Prophylactic
ciprofloxacin and
rifampin is a well-tolerated and highly effective combination that effectively decreases the risk of both gram-positive and
gram-negative bacterial infection following HDC/ASCR. It facilitates outpatient management of myelosuppressed patients receiving autologous stem cell rescue.