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Reply from Jose A Pérez Simón on behalf of the authors

Bone Marrow Transplantation volume 33, pages 975–976 (2004)Cite this article

The issues raised by Nucci et al are important and help to clarify our conclusions. Continued debate surrounds the use of antibiotic prophylaxis for preventing bacterial infections. On the one hand, randomized trials and meta-analyses have shown that the use of prophylaxis with quinolones has led to a decrease in the occurrence of Gram-negative bacteremia and fever. On the other hand, there has been concern that use of these antibiotics may put patients at risk for developing infections with resistant strains of bacteria.1,2,3 These data have led to the recommendation that routine prophylaxis in neutropenic patients should be avoided with the exception of the use of Trimethoprin-Sulfamethoxazole (TMP-SMZ) and maintaining the axiom that antibiotic prophylaxis should be administered for as short a period as possible and to as few patients as possible.4

These issues have been pointed out by Nucci et al as well as ourselves in our recent study,5 where we specified that the approach of starting meropenem on the first day with a granulocyte count <500/mm3 should be monitored carefully and, in the absence of fever, meropenem should be discontinued when >500 granulocytes/mm3 are reached in order to minimize the days of exposure to the antibiotic and to avoid multi-resistant bacteria. We also indicate that further studies using polymerase chain reaction (PCR) to evidence genetic mutations and larger number of patients would be required to confirm these results.

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  1. Department of Hematology Hospital Universitario de Salamanca Paseo de San Vicente s/n Salamanca, 37007, Spain

    Jose A Pérez Simón

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Pérez Simón, J. Reply from Jose A Pérez Simón on behalf of the authors. Bone Marrow Transplant 33, 975–976 (2004). https://doi.org/10.1038/sj.bmt.1704460

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