Prevention of bacterial infection in neutropenic patients with hematologic malignancies: a randomized, multicenter trial comparing norfloxacin with ciprofloxacin
Article Abstract:
Many patients with cancer and prolonged neutropenia (reduced levels of neutrophils, a type of white blood cell) develop serious bacterial infections, often as a result of microorganisms normally present in the digestive tract that enter the bloodstream when the intestine is damaged by chemotherapy. The effectiveness of two relatively new drugs of the fluoroquinolone class, ciprofloxacin and norfloxacin, in preventing such infections was evaluated in this randomized study carried out at several medical centers. The patients had either acute leukemia (a malignancy of white blood cells) or other malignancies affecting blood cells, and entered the study a few days before they began chemotherapy treatments. At entry, patients were randomly assigned to receive either norfloxacin (319 patients) or ciprofloxacin (300 patients). They were carefully monitored for signs of infection: if infection developed, drug therapy continued and antibiotics were added to the regimen. Results showed that more patients who received ciprofloxacin than norfloxacin did not develop fever when neutropenic (34 percent versus 25 percent). Antibiotics were required by more norfloxacin (75 percent) than ciprofloxacin (66 percent) patients, and the duration of antibiotic treatment was shorter in the latter group. Ciprofloxacin was also associated with a lower rate of infection associated with identified microorganisms. Both groups had similar rates of infection, fever, and mortality (approximately 13 percent during episodes of neutropenia). A discussion is presented of the merits of using fluoroquinolones prophylactically in patients with neutropenia, a use that is presently controversial. The main risk factor for developing fever was bone marrow transplantation, a treatment for certain malignancies. The results suggest that ciprofloxacin is effective in preventing infection in neutropenic patients with malignancies of blood cells; however, additional research is needed to learn more about the effects of these drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1991
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The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis: a randomized trial
Article Abstract:
Background: Peripheral vasodilatation is central to the pathogenesis of the accompanying hyperkinetic circulatory state and portal hypertension in cirrhotic patients. Selective intestinal decontamination with norfloxacin has been demonstrated to partially correct nitric oxide production in the forearm vasculature of cirrhotic patients. Objective: To examine the effects of selective intestinal decontamination on regional and systemic hemodynamics in cirrhotic patients. Design: Randomized, double-blind, placebo-controlled, crossover study. Setting: Alfred Hospital, Melbourne, Australia. Patients: 14 patients with alcohol-related cirrhosis and 14 matched healthy controls. Intervention: Norfloxacin, 400 mg twice daily, for 4 weeks. Measurements: Venous occlusion plethysmography was used to determine forearm blood flow. Cardiac output and the hepatic venous pressure gradient were determine after cardiac catheterization. Glomerular filtration rate was assessed by measuring inulin clearance. Serum levels of endotoxin were determined by chromogenic Limulus amebocytelysate assay. Results: Norfloxacin significantly diminished serum endotoxin levels (average change, -2.14 EU/ml [95% CI, -3.6 to -0.68 EU/ml]). Derived systemic vascular resistance increased significantly with norfloxacin (2.94 units [CI, 0.74 to 5.11 units]) and was accompanied by an increase in mean arterial pressure (8.70 mm Hg [CI, 2.65 to 14.73]), a trend toward decreased cardiac output (-1.207 L/min [range, 0.05 to -2.37 L/min]), a decrease in forearm blood flow (-0.99 mL/100 mL per min [CI, -1.80 to -0.17 mL/100 mL per min), and a trend toward reduced hepatic venous pressure gradient (-2.43 mm Hg [CI, -5.2 to 0.34 mm Hg]). Norfloxacin did not significantly alter glomerular filtration rate. Conclusion: Selective intestinal decontamination with norfloxacin partially reverses the hyperdynamic circulatory state in cirrhotic patients without harming splanchnic or renal hemodynamics.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2003
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Oral administration of an antibiotic (norfloxacin) may help treat the cardiac and circulatory complications of liver failure
Article Abstract:
The antibiotic norfloxacin may benefit patients with liver cirrhosis, according to a study of 28 men. Liver cirrhosis causes abnormal changes in blood circulation and researchers believe this is caused by bacteria that would normally be removed by the liver. Norfloxacin did not completely correct the circulatory problems in these men, so other factors may be involved.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2003
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