Infection prophylaxis for the patient with cancer

Despite major advances in treatment, patients with cancer still are plagued by infections. Anti-infection prophylaxis begins with attempts to enhance host defenses, minimize natural barrier alterations, and reduce the number of pathogenic organisms in the patient's environment. Prevention of infection via immunomodulation also is effective to some extent. Immunoglobulin administration, leukocyte transfusion, vaccines, and lithium carbonate are integral parts of this approach to prophylaxis. Antimicrobial modulation also has been attempted. Oral nonabsorbable antibiotics have been used to reduce the number of potentially pathogenic gastrointestinal organisms. Systemic antibiotics have been evaluated for their prophylactic efficacy in patients with cancer. Obstacles to effective systemic prophylaxis include the risk of developing resistant populations of microorganisms and the inordinately large number of potentially pathogenic organisms. The oncology nurse must assume specific responsibilities when administrating prophylactic regimens. There are three crucial issues to be considered: risk factors, aspects of cost and reimbursement, and availability of the most recent treatment options.