Current approaches to management of infections in bone marrow transplants.

D J Winston, W G Ho, R E Champlin
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Abstract

Infections continue to be common complications of bone marrow transplantation, but recent advances have improved their outcome. Oral chemoprophylaxis with the fluoroquinolones has reduced gram-negative infections during periods of granulocytopenia, while new triazole drugs show promise for improving antifungal prophylaxis. Similarly, recombinant hematopoietic growth factors may reduce infections by shortening the period of post-transplant granulocytopenia. The efficacy of double beta-lactam antibiotic therapy or monotherapy with imipenem has obviated the need to use aminoglycosides in the empiric treatment of febrile patients receiving cyclosporine or other nephrotoxic agents. Treatment of post-transplant interstitial pneumonia associated with cytomegalovirus (CMV) remains problematic, but recent results using the combination of ganciclovir plus intravenous immune globulin have been favorable. In CMV-seronegative patients, CMV infections and pneumonia can be prevented or modified by using CMV-seronegative blood products and intravenous immune globulin. Intravenous immune globulin also has the additional benefits of modifying graft versus host disease and preventing late bacterial infections after marrow engraftment. In CMV-seropositive patients, prophylactic ganciclovir may prevent CMV reactivation and pneumonia and is the subject of an ongoing controlled clinical trial.

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骨髓移植感染的当前管理方法。
感染仍然是骨髓移植的常见并发症,但最近的进展已经改善了它们的结果。口服氟喹诺酮类药物预防化疗可减少粒细胞减少症期间的革兰氏阴性感染,而新的三唑类药物有望改善抗真菌预防。同样,重组造血生长因子可能通过缩短移植后粒细胞减少的时间来减少感染。双β -内酰胺类抗生素治疗或亚胺培南单药治疗的疗效使接受环孢素或其他肾毒性药物治疗的发热患者无需使用氨基糖苷类药物。移植后与巨细胞病毒(CMV)相关的间质性肺炎的治疗仍然存在问题,但最近使用更昔洛韦联合静脉注射免疫球蛋白的结果是有利的。在巨细胞病毒血清阴性的患者中,巨细胞病毒感染和肺炎可以通过使用巨细胞病毒血清阴性的血液制品和静脉注射免疫球蛋白来预防或改善。静脉注射免疫球蛋白还具有改善移植物抗宿主病和预防骨髓移植后晚期细菌感染的额外益处。在巨细胞病毒血清阳性患者中,预防性更昔洛韦可能预防巨细胞病毒再激活和肺炎,这是一项正在进行的对照临床试验的主题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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Effect of soybean feeding on experimental carcinogenesis--III. Carcinogenecity of nitrite and dibutylamine in mice: a histopathological study. Abstracts from the second annual meeting of the Danish Society for Cancer Research. 14 April 1989. International Conference on Supportive Care in Oncology. Brussels (Belgium), 23-25 August 1988. Proceedings. Proceedings of the Ondansetron Symposium. London, 30 June 1989. Pharmacological and anti-emetic properties of ondansetron.
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