Abstract:
During the last decade, advances in antimicrobial development have offered viable alternatives to traditional therapy to protect the immunocompromised patient (pt) from the early morbidity and mortality that ensues from untreated bacterial infections. Newer antibiotics (3rd-generation cephalosporins, imipenem, aztreonam and quinolones) are reviewed, covering activity against pathogens commonly encountered in cancer pts (enteric gram-negative, P aeruginosa, coagulase-positive and negative staphylococci, group D and non-group D streptococci, and anaerobes). Systemic fungal infections (due primarily to Candida and Aspergillus species) are a leading cause of severe morbidity and frequent mortality in immunocompromised pts, particularly those with hematologic malignancies, in whom disseminated fungal infections have been associated with a fatality rate of over 70%. Antifungal agents with improved activity and less toxicity are discussed, including imidazoles, fluconazole, itraconazole and liposomal amphotericin B. Herpes viruses are the most common viral pathogens in immunocompromised hosts. Of the six known human herpesviruses, herpes simplex types 1 and 2 (HSV), varicella-zoster virus (VZV) and cytomegalovirus (CMV) most frequently cause morbidity and occasionally death, particularly in pts with impaired cell-mediated immunity (those with lymphomas or HIV infection) and pts undergoing intensive cytotoxic chemotherapy or bone marrow transplantation. Both primary infection and, more often, reactivation of latent herpesviruses are responsible for the clinical illnesses. Neither acyclovir, introduced in the early 1980s, nor any other currently available antiviral agent is capable of eradicating latent viral infections or preventing the establishment of latency. Acyclovir and the related pyrimidine analog, ganciclovir, are not considered new agents, but their recently expanded clinical utility is reviewed. Other antivirals reviewed included foscarnet, for refractory infections due to HSV and CMV, and BV-ara-U, now in clinical trials for treatment of VZV. Colony-stimulating factors, glycoproteins that act on hematopoietic progenitor cells to stimulate their proliferation and differentiation into mature effector cells, have potential utility in attenuating the marrow-toxic effects of chemotherapy and radiotherapy. Although data from large clinical trials are lacking, the encouraging results reported thus far are reviewed. (118 Refs)
Keywords: Acyclovir/THERAPEUTIC USE Amphotericin B/THERAPEUTIC USE Anti-Infective Agents/*THERAPEUTIC USE Antifungal Agents/*THERAPEUTIC USE Antiviral Agents/*THERAPEUTIC USE Aztreonam/THERAPEUTIC USE Bacterial Infections/COMPLICATIONS/*DRUG THERAPY Cephalosporins/THERAPEUTIC USE Colony-Stimulating Factors/THERAPEUTIC USE Fluconazole/THERAPEUTIC USE Foscarnet/THERAPEUTIC USE Ganciclovir/THERAPEUTIC USE Human Imidazoles/THERAPEUTIC USE Imipenem/THERAPEUTIC USE *Immunocompetence Ketoconazole/*ANALOGS & DERIVATIVES/THERAPEUTIC USE Liposomes Mycoses/COMPLICATIONS/*DRUG THERAPY Neoplasms/COMPLICATIONS/IMMUNOLOGY Quinolones/THERAPEUTIC USE JOURNAL ARTICLE 930430
M9340834
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