Levofloxacin Versus Cefpodoxime for Antibacterial Prophylaxis in Allogeneic Stem Cell Transplantation

Abstract Background National guidelines recommend antimicrobial prophylaxis for allogeneic stem cell transplant patients during the pre-engraftment period due to increased infection risk during neutropenia. Fluoroquinolones have demonstrated lower rates of bacteremias and incidence of neutropenic fever, but there is limited evidence in the use of alternative antibacterials such as cefpodoxime. Objectives: The primary objective of this study is to compare the rates of antibiotic prophylaxis failure between levofloxacin and cefpodoxime in allogeneic stem cell transplant recipients. Secondary objectives include comparing and characterizing number and type of infections, mortality at day 100 post-transplant, and hospitalizations for infectious causes in the first 100 days of transplant. Methods This is a single-center, retrospective chart review of adult patients who received an allogeneic stem cell transplant from matched related (MRD) and unrelated (MUD) donors and antibacterial prophylaxis with levofloxacin or cefpodoxime during January 1, 2011 to October 1, 2014. Results A total of 142 patients were evaluated (71 levofloxacin, 71 cefpodoxime). Both levofloxacin and cefpodoxime groups had similar rates of neutropenic fever and antibiotic prophylaxis failure (58% vs. 58%, p=NS). There were similar incidences of C. difficile and MDR infections among both levofloxacin and cefpodoxime groups. Rates of infections, hospitalizations, and mortality in the first 100 days were similar among both groups. Conclusion Cefpodoxime can be used as an alternative to levofloxacin for antibiotic prophylaxis in allogeneic stem cell transplant patients.