Infectious complications in the immunocompromised host. The antimicrobial armamentarium.
The treatment of infectious complications in the cancer patient has evolved as a consequence of the developments in cancer chemotherapy, which significantly impair immune function. Broad-spectrum, single-agent antibiotics have replaced more cumbersome multidrug regimens for empiric coverage of fever and neutropenia in many institutions. The use of new, potent oral antibiotics may be a next step toward further simplifications. Several new antivirals have come into clinical use in the past decade, and reports of viral resistance to the standard agent, acyclovir, have come forth. Increasing experience with new (and older) antifungal and antiparasitic agents has given a better understanding of the use of these drugs for both prophylaxis and treatment. This overview includes a critical appraisal of the attributes and limitations of current antibiotics, antivirals, antifungals, and antiparasitic agents for the immunocompromised host.
Freifeld
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AG
Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000212:Acyclovir / Q000627:therapeutic use; D000617:Aminoglycosides; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001393:Azoles / Q000627:therapeutic use; D001398:Aztreonam / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D024841:Fluoroquinolones; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016867:Immunocompromised Host; D007239:Infections / Q000188:drug therapy*; D009369:Neoplasms / Q000276:immunology*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D014640:Vancomycin / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D001393:Azoles; D002511:Cephalosporins; D024841:Fluoroquinolones; D017245:Foscarnet; D014640:Vancomycin; D015378:Imipenem; D000666:Amphotericin B; D001398:Aztreonam; D015774:Ganciclovir; D000212:Acyclovir