Antibiotic prophylaxis in cancer patients: regimens of oral, nonabsorbable antibiotics for prevention of infection during induction of remission.

The high frequency of complications caused by infections during therapy of malignant diseases has led to the development of prophylactic programs. The most effective prophylaxis has included the use of protected environments and antibiotic regimens (PEPA). Most oral prophylactic regimens include vancomycin to provide coverage against aerobic, gram-positive cocci and some anaerobes. Regimens of nonabsorbable antibiotics are effective in eliminating the vast majority of bacteria from the stool, but the antifungal agents are less effective. However, once the antibiotic regimen is discontinued, organisms previously cultured will reappear. Several prospective, randomized studies have been conducted of patients with acute leukemia who are undergoing chemotherapy administered to induce remission. The frequency of complications caused by infection has been significantly lower for patients in the PEPA program than for controls. A recent study of patients with lymphoma has shown that patients in the PEPA program can tolerate higher doses of chemotherapy than can control patients and that they have lower frequency of complications caused by infection.