Current antimicrobial usage for the management of infections in leukemic patients in Japan: results of a survey.
We report the findings of a questionnaire distributed by the Committee of Supportive Care of the Japan Adult Leukemia Study Group to 196 hospitals throughout Japan. For antimicrobial prophylaxis, the oral quinolones are prescribed by 38% of physicians and polymixin B by 31%. For antifungal prophylaxis, amphotericin B is prescribed by 42% of physicians and fluconazole by 41%. Febrile neutropenia is empirically treated with cephalosporin or carbapenem monotherapy by 35% of physicians. Overall, dual therapy (i.e., an aminoglycoside plus a cephalosporin, a carbapenem, or an antipseudomonal penicillin) is prescribed by 50% of physicians. When response to initial empirical therapy does not occur after 3-4 days, 51% of physicians add an antifungal agent; fluconazole is preferred to amphotericin B (prescribed by 66% vs. 28% of physicians). For the treatment of fungemia due to Candida albicans, fluconazole was prescribed by 59% of physicians in cases of stable disease and amphotericin B was prescribed by 57% of physicians in cases of unstable disease. Amphotericin B is selected to treat invasive aspergillosis, but a dose of 0.5-0.7 mg/kg, inadequate for this disease, is prescribed by 44% of physicians. Granulocyte colony-stimulating factor is prescribed to treat patients with acute myelogenous leukemia who have life-threatening infections (27% of physicians) or who have clinically or microbiologically documented infections (26% of physicians).
Yoshida
Minoru
M
Fourth Department of Internal Medicine, Teikyo University School of Medicine, Kawasaki City, Japan. myoshida@med.teikyo-u.ac.jp
Ohno
Ryuzo
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000188:drug therapy; D016469:Fungemia / Q000188:drug therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007564:Japan; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000276:immunology*; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000188:drug therapy*; D012074:Remission Induction
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor