Efficacy of Levofloxacin Prophylaxis for Fever, Bacteremia, and Bacterial Infections in Children with Acute Leukemia and Chemotherapy-Induced Neutropenia
Abstract
Children with acute leukemia undergoing chemotherapy frequently develop chemotherapy-induced neutropenia (absolute neutrophil count <500/μL), significantly increasing their risk for infections, sepsis, and mortality. Prophylactic levofloxacin is recommended for adults with profound neutropenia, but evidence in pediatric populations with non-profound neutropenia remains limited. This study aimed to evaluate the efficacy of levofloxacin prophylaxis in reducing infection-related complications in children with acute leukemia.
A quasi-experimental, non-randomized, controlled trial was conducted from May 2023 to May 2024 in three tertiary pediatric care centers in Mexico. Sixty pediatric patients with acute leukemia and chemotherapy-induced neutropenia were enrolled, with 30 receiving levofloxacin prophylaxis (10 mg/kg daily; maximum dose 750 mg) and 30 matched historical controls. Biomarkers of infection (e.g., procalcitonin >0.5 ng/mL), fever incidence, bacteremia, and mortality were measured. Statistical analyses included Chi-square and Mann-Whitney U tests.
The intervention group demonstrated significantly lower rates of fever (23.3% vs. 58.3%, p=0.03) and bacteremia (18.3% vs. 41.7%, p=0.02) compared to controls. Infection-related complications, including sepsis and septic shock, were significantly reduced in the levofloxacin group (20% vs. 46.7%, p=0.02). Mortality was also lower in the prophylaxis group (13.3% vs. 33.3%, p=0.04). Pathogens frequently isolated included…
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