Cotrimoxazole prophylaxis in patients with leukemia and prolonged granulocytopenia

Sixty-three patients with acute nonlymphoid leukemia (ANLL) under cytostatic treatment were investigated in a randomized trial to determine whether oral administration of cotrimoxazole (TMP/STX) would reduce the rate of infection. Four significant differences were observed between the group given TMP/STX (30 patients) and the control group (33 patients): 1) the mean duration of severe granulocytopenia (≤500 PMN/mm3) before the first febrile episode was longer in prophylaxis group, 14.26 days versus four in the control group (p<0.001); 2) the number of febrile episodes was 37 in TMP/STX group and 69 in control group (p<0.01); 3) 23 patients on prophylaxis presented at least one febrile episode versus 33 in the control group (p<0.01); 4) deaths due to infection were two in the TMP/STX group versus 11 in control group (p<0.05). Prophylaxis with TMP/STX appears to be useful since by reducing the number of febrile episodes and deaths due to infection, it increases the survival of leukemia patients under cytostatic drugs. Nevertheless further studies on a larger number of patients are necessary in order to confirm the true efficacy of the drug in the reduction of sepsis and death due to infection.