Cancer patient infection prophylaxis

The immunorestorative potential of inosiplex has been evaluated in several clinical conditions, including post-surgical trauma, cancer patients with concurrent viral infections, and cancer patients receiving radiotherapy or chemotherapy. For example, most (84%) of the surgery patients remained immunologicaHy depressed, but 56% of the inosiplex-treated surgery patients had complete restoration of normal skin test reactivity (probability level < 0.0005). The use of inosiplex as an adjuvant to chemotherapy or radiotherapy appears to be valuable in the prophylaxis against opportunistic infections. 

Boogaerts M, Maertens J, van Hoof A, de Bock R, Fillet G, Peetermans M, Selleslag D, Vandercam B, Vandewoude K, Zachee P, De Beule K. Itraconazole versus amphotericin B plus nystatin in the prophylaxis of fungal infections in neutropenic cancer patients. J Antimicrob Chemother 2001 48(1) 97-103. 

Rotstein C, Bow EJ, Laverdiere M, et al. Randonuzed placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients Benefit based on purpose and intensity of cytotoxic therapy. Qin Infect Dis 1999 28 331-340. 

Owing to the potential morbidity and mortality of infections in neutropenic cancer patients, measures have been taken to prevent these complications through a number of environmental modifications and prophylactic antimicrobial regimens. The goal of antimicrobial prophylaxis in cancer patients is to decrease the number and severity of systemic infections during prolonged periods of neutropenia. Decisions regarding prophylactic antimicrobials must be made with the realization of associated issues, such as resistance concerns. 

The use of trimethoprim-sulfamethoxazole in cancer patients at risk for P. jiwveci pneumonia has reduced the incidence of this protozoal infection substantially. Antiviral prophylaxis with acyclovir or newer agents (valacyclovir and famciclovir) is employed in most centers to reduce the risk of HSV reactivation in patients with acute leukemia undergoing intensive chemotherapy. Varicella vaccine provides good protection (90%) in leukemic children and also may be useful in seronegative adults, although the vaccine has been less well studied in this population. 

Antibiotic prophylaxis, often with an oral fluoroquinolone, is used to prevent a variety of infections in patients undergoing organ transplantation or receiving cancer chemotherapy. Prophylaxis is recommended for primary and secondary prevention of opportunistic infections in AIDS patients whose CD4 counts are below certain thresholds (e.g., <200 cell/mm for the prevention of Pneumocystis pneumonia and <50 cells/mm for prevention of atypical mycobacterial infections). 

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