Background and rationale {6a}
neutropenia, musculoskeletal and neurological adverse, dermatological infections, infection, hematologic
URINARY TRACT INFECTIONS, NEUTROPENIA, CNS INFECTIONS, INFECTION, EVENTS, GASTROINTESTINAL TRACT INFECTIONS
The use of fluoroquinolones (FQ) ciprofloxacin or levofloxacin is an established practice for the prevention of infectious events in hematologic patients in whom long lasting and profound neutropenia (absolute neutropenia count ≤ 0.1/ × 10The concerns about the increasing incidence of MRGNB and its risks have led to questioning the actual recommendation of FQ prophylaxis, especially in those settings with a baseline resistance rate above 20% [In addition to multidrug resistance associated to FQ, musculoskeletal and neurological adverse events (AEs) related to them represent another problem. For this reason, the European Pharmacovigilance Risk Assessment Committee recommends restricting their use (Finally, another aspect for which FQ may adversely impact the outcome of patients is the modification of the intestinal microbiota. It has been demonstrated that replacement of the normal fecal microbiota with an abnormal one occurs in patients undergoing allogeneic HSCT [All the aforementioned limitations related to FQ prophylaxis have pointed to the urgent need for exploring new prophylactic drugs. In the past decades, other drugs were evaluated without positive results. This is the case of cephalosporins [Fosfomycin is a broad-spectrum bactericidal antibiotic approved for the treatment of uncomplicated urinary tract infections, gastrointestinal tract infections, and dermatological infections caused by microorganisms sensitive to this antibiotic. It has activity against Gram-positive and Gram-negative microorganisms and against extended-spectrum B-lactamase In view of the above, the need of conducting this study is justified. The results could demonstrate the non-inferiority of oral fosfomycin compared to oral ciprofloxacin in preventing infections in patients with neutropenia at high risk of developing infection as well as its effect on the intestinal flora as assessed by surveillance cultures and fecal microbiota analysis.