[Intestinal Decontamination in the Neutropenic Patient. Apropos of a Prospective Randomized Study]

Sixty-five patients undergoing remission-induction chemotherapy for acute leukemia in a protected environment unit were randomly assigned to selective antimicrobial modulation of the intestinal flora (SAM) with trimethoprim-sulfamethoxazole, or total antibiotic decontamination (TAD) with gentamicin, vancomycin and colimycin. Digestive tract colonization with Streptococcus D was more prevalent in the SAM group (p less than 0.01); colonization with yeasts was more prevalent in the TAD group (p less than 0.001). However, there was no difference between the two groups as regards to clinically and microbiologically documented infections, septicemias and survival. Selective antimicrobial modulation with trimethoprim-sulfamethoxazole is as effective and cheaper than total antibiotic decontamination with gentamicin, vancomycin and colimycin.