Levofloxacin Prophylaxis Does Not Reduce Infection or Mortality in Pediatric Allo-HCT

Overview

In a retrospective study of 144 pediatric and young adult allogeneic hematopoietic stem cell transplant recipients, levofloxacin prophylaxis did not significantly reduce bloodstream infections, acute graft-versus-host disease, or infection-related mortality. However, prophylaxis was associated with increased incidence of quinolone-resistant bacterial strains and alterations in gut microbiota composition.

Background

Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a critical treatment for various hematological disorders in children but carries a high risk of infectious complications. Bacterial infections remain a major cause of morbidity and mortality in this population. While quinolone antibiotics like levofloxacin have been used prophylactically in adults to reduce infections, evidence in pediatric allo-HCT recipients is limited and controversial. Concerns also exist regarding antibiotic resistance and gut microbiota disruption associated with prophylactic use.

Data Highlights

Key Findings

• Levofloxacin prophylaxis did not significantly reduce the incidence of bloodstream infections or acute graft-versus-host disease compared to no prophylaxis.
• There was no significant difference in infection-related mortality between patients receiving levofloxacin prophylaxis and those who did not.
• Patients receiving levofloxacin prophylaxis had a significantly higher incidence of quinolone-resistant bacterial strains during infections.
• Gut microbiota analysis showed lower abundance of beneficial genera such as Blautia and Enterococcus at neutrophil engraftment in patients receiving levofloxacin prophylaxis.
• The study supports concerns about antibiotic resistance and gut microbiota dysbiosis associated with levofloxacin prophylaxis in pediatric allo-HCT recipients.

Clinical Implications

Routine use of levofloxacin prophylaxis in pediatric and young adult allo-HCT recipients does not confer clear benefits in preventing infectious complications or reducing mortality. Clinicians should weigh the risks of promoting antibiotic-resistant bacteria and disrupting gut microbiota against the lack of demonstrated efficacy. Antimicrobial stewardship programs should consider limiting prophylactic quinolone use in this population and focus on prompt treatment of febrile neutropenia.

Conclusion

Levofloxacin prophylaxis in pediatric allo-HCT recipients does not improve key transplant outcomes and is associated with increased antibiotic resistance and gut microbiota alterations. These findings argue against routine prophylactic use of levofloxacin in this setting.

References

1. Author/Source/2023 -- Efficacy of Levofloxacin Prophylaxis in Preventing Infectious Complications and Mortality in Pediatric and Young Adult Recipients of Allogeneic Hematopoietic Stem Cell Transplantation