Empiric Amphotericin B Therapy in Patients with Acute Leukemia
| Autor: | Michael W. DeGregorio, Jordan R. Wilbur, Walter M. Holleran |
|---|---|
| Rok vydání: | 1985 |
| Předmět: |
Microbiology (medical)
Neutropenia Fever Monocyte chemotaxis medicine.drug_class Population Antibiotics Administration Oral Disease Amphotericin B medicine Humans Blood Transfusion education Mycosis Clinical Trials as Topic education.field_of_study Acute leukemia Leukemia business.industry medicine.disease Infectious Diseases Mycoses Acute Disease Immunology business Granulocytes medicine.drug |
| Zdroj: | Clinical Infectious Diseases. 7:619-624 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/clinids/7.5.619 |
| Popis: | Invasive fungal infections remain a considerable problem in the management of patients with acute leukemia. This review discusses and provides guidelines for empiric treatment in such circumstances, with emphasis on the use of amphotericin B. The topics covered include (1) the risk factors associated with the development of fungal infections; (2) the difficulties of diagnosing a fungal infection; (3) the empiric use of amphotericin B (with a review of clinical trials and dosing guidelines); and (4) the role of other therapeutic measures in oral prophylaxis and treatment. Although other organisms have been shown to cause fungal infections in patients with acute leukemia, only Candida and Aspergillus species are discussed formally in terms of diagnosis and therapy. Patients with acute leukemia are at increased risk for the development of all types of infections. Recently, an increasing incidence of disseminated fungal infections has been observed in this population [1, 2]. Autopsy studies have shown that 25%-50%o of patients with hematologic malignancies have documented fungal infections [3, 4]. The immunocompromised state that places these patients at increased risk for disseminated fungal infections can be attributed partly to the leukemic disease itself. The compromised host response appears to stem from functional abnormalities within the granulocytes- changes that are manifested as a phagocytic abnormality-and possibly from a decreased cellular antibody response, with impaired monocyte chemotaxis [5-7]. In addition, myelosuppression and subsequent granulocytopenia secondary to induction chemotherapy, although directly related to therapeutic response in patients with leukemia, increase the risk of fatal fungal infections [8]. Several other risk factors have been associated with the development of disseminated fungal infections in patients with acute leukemia; these factors include prolonged antibacterial therapy [8-10]. |
| Databáze: | OpenAIRE |
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