Shinohara, A., Yoshiki, Y., Masamoto, Y., Hangaishi, A., Nannya, Y., & Kurokawa, M. (2013). Moxifloxacin is more effective than tosufloxacin in reducing chemotherapy-induced febrile neutropenia in patients with hematological malignancies. Leukemia and Lymphoma, 54, 794–798.
To evaluate the efficacy of antibiotic prophylaxis with tosufloxacin or moxifloxacin in adult patients (aged 16 years or older) with hematologic malignancies who were treated with chemotherapy that induced neutropenia and had an absolute neutrophil count less than 500/mcL for five days or longer
From 2004–2006, patients were treated with prophylactic tosufloxacin 150 mg three times daily, and from 2007–2008, patients were treated with prophylactic moxifloxacin 400 mg daily. All patients in both groups were treated with prophylactic antifungal therapy with either fluconazole or itraconazole.
Comparison of moxifloxacin to tosufloxacin demonstrated a significantly decreased cumulative incidence of febrile neutropenia (74.7% [59 of 79] and 81.1% [219 of 270], respectively, p = 0.044]; increased incidence of fungal infection in the moxifloxacin group (10.1% compared to 4.1% in the tosufloxacin group, p = 0.048); and no cases of CDAD in either group. No significant difference was seen between groups for the mean duration of neutropenia (17.6 days and 17.9 days, respectively, p = 0.853); documented infection (20.3% and 25.9%, respectively, p = 0.373); mortality (0% and 1.9%, respectively, p = 0.592); or fluoroquinolone-resistant infections (7.6% and 9.3%, respectively, p = 0.823). A subgroup analysis of patients with AML showed a higher incidence of febrile neutropenia in the tosufloxacin group (94.1% versus 71.1%, p = 0.013), perhaps related to the observation that the patients with AML had a longer duration of neutropenia (mean = 20.6 days) than the other patients (mean = 13 days) (p < 0.01). A second subgroup analysis showed that moxifloxacin was more effective in preventing febrile neutropenia in patients with neutropenia lasting 15 days or longer (incidence: 73.8% and 89.7%, respectively, p = 0.008) and had no effect on the incidence in patients with neutropenia lasting 14 days or less (p = 0.930).
Moxifloxacin was more effective than tosufloxacin in preventing febrile neutropenia in patients with AML who were most likely to have a longer duration of neutropenia (15 days or longer). No differences in the incidence of documented infections, fluoroquinolone-resistant infections, or overall mortality were observed.
Antibiotic prophylaxis with moxifloxacin is more effective than tosufloxacin in reducing the incidence of febrile neutropenia in high-risk patients who are expected to have a long duration of neutropenia. However, moxifloxacin was associated with more fungal infections. Nurses need to educate and counsel patients regarding antibiotic prophylaxis to enhance adherence, appropriate side effect reporting, and self-monitoring for signs of infection.