meropenem and fosfluconazole

Invasive fungal infection (IFI) is a serious complication of chemotherapy for hematological malignancies and autologous/allogeneic hematopoietic stem cell transplantation in children and shows a high mortality rate. We performed a randomized trial comparing micafungin (MCFG), a new anti-fungal agent, with fosfluconazole, a prodrug of fluconazole (FF) conventionally used as a prophylactic agent, for prophylaxis against IFI. Cefpirome was administered as prophylaxis against bacterial infection, and meropenem+minocycline as an empiric window therapy for febrile neutropenia. MCFG 2 mg/kg/day (max 100 mg/day) and FF 10 mg/kg/day (max 400 mg/day) were both safe and effective (event free ratio of IFI, MCFG 94.4% vs FF 94.3%) without significant difference. Thus, MCFG is safe and can be used for prophylaxis against IFI in children.

Topics: Adolescent; Child; Child, Preschool; Drug Therapy, Combination; Echinocandins; Female; Fluconazole; Hematopoietic Stem Cell Transplantation; Humans; Infant; Lipopeptides; Male; Meropenem; Micafungin; Minocycline; Mycoses; Neutropenia; Opportunistic Infections; Organophosphates; Prodrugs; Thienamycins

A 31-year-old female with acute myelocytic leukemia was admitted to our hospital in June 2004. She had complications of brain abscess at the WBC nadir after the second course of induction therapy. However,because the platelet count was low, neurosurgical procedures, including craniotomy/abscess resection, or abscess drainage, were not performed, and we could not detect bacteria or fungus as the cause of brain abscess. Combination therapy with meropenem trihydrate and fosfluconazole was effective. Thereafter, she underwent related peripheral blood stem cell transplantation, and has had no recurrence of brain abscess. Brain abscess during chemotherapy for patients with acute leukemia is commonly due to fungus,particularly Aspergillus, which has a very high fatality rate. Therefore, the treatment of brain abscess without the detection of bacteria and fungus requires combination therapy with antifungal agents and antibiotics. In this case, methionine-positron emission tomography was useful for the evaluation of therapeutic effectiveness for brain abscess.

Topics: Adult; Antifungal Agents; Brain; Brain Abscess; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluconazole; Humans; Leukemia, Myeloid, Acute; Meropenem; Organophosphates; Peripheral Blood Stem Cell Transplantation; Positron-Emission Tomography; Thienamycins; Tomography, X-Ray Computed