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Management of infections in the neutropenic child with cancer
1Division of Infectious Disease and Immunology, University of Miami, School of Medicine, Florida.
Insights
Advances in managing infections in neutropenic cancer patients include new antibiotics and colony-stimulating factors. These strategies improve treatment for gram-negative and gram-positive infections, aiding in neutropenia correction.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Significant progress has been made in managing infectious complications in pediatric cancer patients with neutropenia over the past two decades.
- Traditional methods like protected environments and white blood cell transfusions have shown limited clinical efficacy.
Purpose of the Study:
- To review recent advancements in the therapeutic and prophylactic management of infections in neutropenic children with cancer.
- To highlight the evolving landscape of antimicrobial agents and supportive therapies.
Main Methods:
- Review of recent literature on antimicrobial agents and supportive care for neutropenic patients.
- Analysis of the clinical role of new antibiotic classes, vancomycin, and colony-stimulating factors.
Main Results:
- New penicillin classes, aztreonam, and third-generation cephalosporins have improved treatment for gram-negative infections, including Pseudomonas aeruginosa.
- Re-emergence of gram-positive pathogens led to vancomycin's reintroduction and development of beta-lactamase inhibitor agents.
- Quinolones show promise for bacterial infection prevention in adults; recombinant human hematopoietic colony-stimulating factors are effective in correcting neutropenia.
Conclusions:
- The therapeutic armamentarium for gram-negative and gram-positive infections in neutropenic children has significantly expanded.
- Prophylactic strategies, including potential roles for quinolones and colony-stimulating factors, are improving infection control.
- Ongoing research continues to refine the management of infectious complications in this vulnerable population.
Abstract:
The last two decades have witnessed significant improvements in the management of infectious complications in the neutropenic child with cancer. Protected environments and the use of white blood cell transfusions have been found to have a limited clinical role. The development of new classes of pencillins, the monobactam aztreonam, and the third generation cephalosporins have expanded the therapeutic armamentarium available for treating gram-negative infections including Pseudomonas aeruginosa. The re-emergence of gram-positive organisms as common pathogens in these patients has prompted the reintroduction of vancomycin into general clinical use. Increased incidence of gram-positive infections also led to the development of agents containing the beta-lactamase inhibitor clavulanic acid. Attempts at prevention of bacterial infections in the neutropenic patient have been partially successful. Recent studies in adults suggest that the quinolone group of antibiotics may be the ideal agents for this purpose. Finally, the availability of recombinant human hematopoietic colony-stimulating factors may represent a significant advance in efforts to prevent infections. Early studies in animals and in humans suggest that these cell growth factors are effective in correcting neutropenia.