Infection Prevention during Induction Chemotherapy in Children with Acute Leukemia

A Comparison of Total Antimicrobial Modulation with Selective Antimicrobial Modulation of the Intestinal Flora

Abstract

Forty-four children with acute leukemia during induction therapy in private-room isolation were prospectively randomized to receive either total antimicrobial modulation (TAM) regimen (Polymyxin B, Kanamycin and Amphotericin B) or selective antimicrobial modulation (SAM) regimen based on the concept of colonization resistance (Trimethoprim-Sulfamethoxazole and Amphotericin B) for prevention of infection, and compared to historical controls in private-room isolation only. Both TAM group and SAM group had significantly decreased incidence of infection per hospitalization and percentage of days febrile to total days (7.1 % in the TAM group versus 4.0% in the SAM group versus 25.0% in the control group, p<0.005). Pneumonia, upper respiratory tract infection, urinary tract infection, colitis, and otitis media occurred less frequently among recipients of TAM and SAM. No Pseudomonas aeruginosa, Escherichia coli, Klebsiella and Proteus species were found in TAM group and SAM group. Infectious deaths were reduced in TAM group and SAM group. The TAM group and SAM group also had higher complete remission rates. However, there were no significant differences between the two treatment groups in the effect of gut decontamination on prevention of infection. SAM group regimen is cheaper and easier to take than TAM group regimen, and it is therefore preferable to TAM group regimen for the prophylaxis of infection.