Increased Risk of Acute Graft-Versus-Host Disease with Some Antibiotics - European Medical Journal

Increased Risk of Acute Graft-Versus-Host Disease with Some Antibiotics

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SOME antibiotics are associated with a higher risk for acute graft-versus-host disease (GvHD) than others in the treatment of neutropenic fever and infections following allogeneic hematopoietic cell transplantation, according to a recent cohort study. This association was the most consistent with carbapenems in the 2 weeks following the procedure, leading to the team to conclude that “avoiding this class of antibiotics early after transplant seems prudent.”

Acute GvHD risk was assessed in more than 2,000 adults (median age: 55 years; 57% male) undergoing the treatment, with exposure to antibiotics examined from 7 days before transplant to 30 days after.  In total, 72% of patients developed Grade II–IV acute GvHD in 180 days following transplant, with 15% of patients developing Grade III–IV. Mortality occurred in 14% and 35%, respectively.

The researchers noted that apart from carbapenems, the following antibiotics were also associated with a greater risk of acute GvHD: penicillin with a β-lactamase inhibitor, third-generation or later cephalosporins, fluoroquinolones, trimethoprim sulfamethoxazole, oral or intravenous vancomycin, aztreonam, and penicillins. This increased risk may be linked to microbiota injury in the peri-transplant period. The team also noted a higher risk interval in Weeks 1 and 2. Interestingly, the team noted that exposure to penicillin with a β-lactamase inhibitor in the week before allogeneic hematopoietic cell transplantation was linked to statistically significantly lower risk of acute GvHD.

The results of this study could have big implications for patients, as they may lead to antimicrobial stewardship programmes. “Preserving the effectiveness of antibiotics and mitigating against antibiotic resistance remain integral to supporting patients throughout their cancer treatment,” said Miranda So, University of Toronto, Canada. While prescribers may believe the antibiotics to be protective for patients in the pre-engraftment phase and susceptible to infections, these may be harmful for the patient.

Limitations of the study included that the authors were not aware of reasons for antibiotic choice. They concluded: “If our results are replicated in independent cohorts, antibiotic-associated risk of [acute GvHD] could become a consideration in antibiotic stewardship programmes.”

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