Journal of Clinical Oncology, Vol 1, 302-307, Copyright © 1983 by American Society of Clinical Oncology
Trimethoprim/sulfamethoxazole versus placebo: a double-blind comparison of infection prophylaxis in patients with small cell carcinoma of the lung
CA de Jongh, JC Wade, RS Finley, JH Joshi, J Aisner, PH Wiernik and SC Schimpff
The suppression of pathogenic aerobes and the preservation of anaerobes
provides a degree of infection prevention during granulocytopenia.
Trimethoprim/sulfamethoxazole (TMP/SMZ) suppresses Enterobacteriaceae and
probably maintains colonization resistance through sparing of anaerobes.
TMP/SMZ (320/1600 mg/day) treatment was compared to placebo in a
double-blind, randomized trial in patients with newly diagnosed small cell
carcinoma of the lung during the initial courses of chemotherapy with
cyclophosphamide, doxorubicin, and etoposide. Infections were evaluated as
microbiologically documented, with or without bacteremia, and clinically
documented and were correlated to granulocytopenia. Of the 61 patients
evaluated, 32 were given TMP/SMZ and 29 were given placebo; both groups had
similar characteristics with regard to disease extent, performance status,
age, sex, chemotherapy, and days of granulocytopenia. Incidence of
infection at less than 100 granulocytes/microliters was significantly
reduced in the TMP/SMZ group (2 infections/100 days) compared to placebo
(11 infections/100 days, p = 0.005). Also reduced were the number of
bacteremias and the mean proportion of study time on broad-spectrum
antibiotics (p less than 0.01). Compared to placebo, TMP/SMZ provided
infection prophylaxis without an increase in marrow suppression among
patients with small cell carcinoma of the lung receiving intensive
chemotherapy.
