【IG:Pharmabook】評論

koda & kimble 10th appliedp.2259 case 96-6異體移植的骨髓淨除性移植前調適治療，會包括以下面向1.抗菌、抗黴菌、抗病毒用藥(1)抗菌：預防性投予 廣效抗G(-)的抗生素，可預防病人嗜中性白血球低下(ANC <1,000 cells/μL)如果預期neutropenic時間大於7天，有些人會給予Levofloxacin類(A)的FQ  (2)抗黴菌：常用fluconazole 400 mg/day預防，但可能會產生抗藥性 C. glabrata and Aspergillus在一篇異體移植病人的RCT中，比較 micafungin 50 mg IV QD(B) VS fluconazole (400 mg IV every 24 hours)Micafungin有顯著較好的效果(80.0% vs. 73.5% , p=0.03)，與較少的aspergillosis復發(3)抗病毒常使用acyclovir 或 valacyclovir  500 mg PO Q12H(C)Aggressive use of antibacterial, antifungal, and antiviral therapy, both prophylactically and for documented infection, is an important aspect of patient management【Anti-bacteria】Antibiotics with a broad gram-negative spectrum may be instituted prophylactically once the patient becomes neutropenic (ANC <1,000 cells/μL), or empirically after the patient is neutropenic and experiences fever (oral temperature >38◦C). Some transplant centers administer a prophylactic fluoroquinolone such as levofloxacin on admission especially if the neutropenic period is expected to extend beyond 7 days 【Anti-fungal】Micafungin (50 mg IV every 24 hours) and fluconazole (400 mg IV every 24 hours) were compared in a randomized, double-blind study of patients undergoing HCTThe overall efficacy was greater in the patients who received micafungin (80.0% vs. 73.5% in patients treated withfluconazole, p = 0.03). Fewer episodes of aspergillosis occurred in patients treated with micafungin【Anti-viral】Prophylactic acyclovir is commonly used in HSV-seropositive patients undergoing allogeneic or autologous HCT to prevent viral reactivationProphylactic valacyclovir is commonly used at a dose of 500 mg PO every 12 hours附上Case 96-6 原文Prevention and Treatment of Bacterial and Fungal InfectionsCASE 96-6QUESTION 1: S.D. is a 26-year-old woman with Ph+ acute lymphocytic leukemia in first complete remission who is admitted for allogeneic myeloablative HCT. The following orders are written: Admit to a room with a positive-pressure HEPA filter. Flush double-lumen Hickman catheter per protocol. Immunosuppressed patient diet as tolerated. Begin fluconazole 400 mg PO every 24 hours and levofloxacin 500 mg PO every 24 hours on admission. Begin ceftazidime 2 g IV every 8 hours with first fever when ANC is less than 500 cells/μL. Transfuse 2 units of packed RBCs for hematocrit less than 25% and 1 unit of single-donor platelets for platelet count less than 20,000/μL. What is the rationale for these supportive measures?