Rifaximin Versus Levofloxacin: A Comparative Analysis of Prophylactic Efficacy in Allogeneic Stem Cell Transplantation.

This study aims to compare the effects of rifaximin and levofloxacin prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT) on the development of graft-versus-host disease (GVHD), length of hospital stay, engraftment duration, initiation of broad-spectrum antibiotics, incidence of febrile neutropenia, relapse rates, readmission periods, and transplant-related mortality. A total of 116 patients aged over 18 who underwent allogeneic HSCT between 2018 and 2022 were included. Exclusion criteria included the use of broad-spectrum antibiotics on the day of transplantation. Of these, 58 patients received rifaximin, and 58 received levofloxacin as prophylaxis. Levofloxacin was associated with a significantly lower incidence of febrile neutropenia in patients with acute myeloid leukemia (AML) compared to rifaximin (P = .017). Among other patient groups, levofloxacin prophylaxis also resulted in a lower fever incidence (P = .031). Levofloxacin demonstrated greater efficacy than rifaximin in reducing the incidence of transition to broad-spectrum antibiotic therapy (P = .008). Among the 116 patients, 54 were readmitted within the first 100 days post-transplantation. Among these, the predominant reason for readmission was infection, followed by graft-versus-host disease (GVHD). The use of levofloxacin prophylaxis was linked to a remarkably lower rate of readmissions (P = .004). In patients with acute lymphoblastic leukemia (ALL), levofloxacin also showed a significant advantage in terms of readmission rates. Moreover, individuals who received levofloxacin for prophylaxis experienced reduced mortality rates (P = .011).