Vancomycin plus gentamicin and cotrimoxazole for prevention of infections in neutropenic cancer patients (a comparative, placebo-controlled pilot study)

Abstract

Vancomycin and gentamicin, cotrimoxazole, or vancomycin and gentamicin plus cotrimoxazole were administered respectively to 21, 22 and 20 cancer patients with neutropenia in order to prevent infection. The administration of cotrimoxazole was associated with less infections than that of vancomycin plus gentamicin. The administration of vancomycin and gentamicin plus cotrimoxazole was associated with no Gram-negative bacillary infections at all, but the tolerance to this latter regimen was less good and was associated with a 40% rate of discontinuation of the prophylactic therapy because of adverse effects, namely nausea and diarrhea. Cotrimoxazole administration was associated with less complete microbial suppression of the aerobic Gram-negative bacilli in the digestive tract than vancomycin plus gentamicin. In addition, in cotrimoxazole-treated patients a high incidence ( 66%) of cotrimoxazole-resistant Gramnegative aerobic bacilli was found, whereas it was much lower in the two other study groups. It is concluded that the use of cotrimoxazole in addition to vancomycin and gentamicin to prevent infection in neutropenic cancer patients might have some advantages and should be evaluated in more extensive studies.