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Antimicrobial prophylaxis in bone marrow transplantation

F Momin¹, P H Chandrasekar

¹Wayne State University, Detroit, Michigan, USA.

Annals of Internal Medicine

|August 1, 1995

Summary

Antimicrobial prophylaxis in bone marrow transplantation can prevent common infections but does not always improve survival. Strategies require careful evaluation for toxicity and cost-effectiveness.

Area of Science:

Hematology
Infectious Diseases
Pharmacology

Background:

Bone marrow transplantation (BMT) recipients are highly susceptible to infections due to profound immunosuppression.
Prophylaxis with antimicrobial agents is a critical component of supportive care in BMT.

Purpose of the Study:

To review the efficacy of various antimicrobial prophylaxis strategies in bone marrow transplantation.
To evaluate the impact of prophylaxis on bacterial, viral, and fungal infections.

Main Methods:

Systematic review of English-language literature from 1975 to 1994.
MEDLINE search and review of bibliographies of selected articles.
Inclusion of studies on antimicrobial agents for infection prevention in BMT recipients and neutropenic cancer patients.

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Main Results:

Quinolones reduce Gram-negative infections but increase Gram-positive infections.
Ganciclovir and high-dose acyclovir show efficacy against cytomegalovirus (CMV) and herpes simplex virus (HSV), respectively, with associated concerns.
Fluconazole is effective against certain Candida species, while trimethoprim-sulfamethoxazole reduces Pneumocystis pneumonia and late bacterial infections.
No optimal prophylaxis exists for Aspergillus or post-engraftment fungal infections.

Conclusions:

Antimicrobial prophylaxis can prevent common early infections in BMT patients.
Survival benefit from prophylactic strategies is not consistently demonstrated.
Critical evaluation of toxicity and cost-effectiveness is essential for optimal antimicrobial prophylaxis in BMT.