Obesity not associated with increased risk for febrile neutropaenia during levofloxacin prophylaxis

Obesity is not a good reason to initiate more aggressive levofloxacin dosing schemes when used for febrile neutropaenia prophylaxis in patients with haematological malignancies receiving intermediate-risk myelosuppressive chemotherapy, suggests a study.

Adult patients with estimated creatinine clearance ≥50 mL/min receiving their first cycle of a National Comprehensive Cancer Network-defined intermediate-risk regimen were included and evaluated in this single-centre, retrospective cohort study from June 2014 to May 2017.

The primary endpoint of incidence of febrile neutropaenia occurred in 26 patients, of whom 12 (35.3 percent) were obese and 14 (21.9 percent) were nonobese (p=0.16). Six patients (23.1 percent) required intensive care, but no deaths occurred within 30 days of a febrile neutropaenia event.

Obese and nonobese patients showed similar estimated creatinine clearance (median, 97.5 vs 91.8 mL/min; p=0.39), as well as estimated levofloxacin area under the concentration–time curve (median, 85.6 vs 90.8 mg×h/L; p=0.39).

Body weight-related variables, such as total body weight (median 83.4 vs 80.6 kg; p=0.51), body mass index (mean, 29.6 vs 26.8 kg/m²; p=0.35), or body surface area (1.98 vs 1.99 m²; p=0.68), were not significantly associated with febrile neutropaenia in this cohort of patients with similar renal function.

“Levofloxacin given at a standard dose of 500 mg daily is recommended for antibacterial prophylaxis in patients receiving myelosuppressive chemotherapy,” the authors said. “Obese patients have been shown to exhibit enhanced clearance of levofloxacin and may be at risk for prophylactic failure.”