acyclovir and Streptococcal-Infections

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Infant, Newborn; Injections, Intravenous; Male; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Streptococcal Infections

The purpose of the study reported here was to investigate the impact of prophylaxis against gram-positive infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplantation in a randomized trial. Forty-three patients undergoing high-dose chemotherapy with autologous bone marrow transplant were enrolled in a nonblinded randomized trial to receive or not to receive prophylaxis for gram-positive infections with 10(6) U of penicillin intravenously (i.v.) every 6 h (q6h) (if penicillin allergic, 750 mg of vancomycin i.v. q12h) in addition to standard antimicrobial prophylaxis with 400 mg of norfloxacin orally three times a day, 200 mg of fluconazole orally once a day, and 5 mg of acyclovir per kg of body weight i.v. q12h. The patients were being treated for germ cell cancer (n = 15), breast cancer (n = 16), Hodgkin's disease (n = 3), non-Hodgkin's lymphoma (n = 4), acute myeloid leukemia (n = 1), acute lymphoblastic leukemia (n = 1), and ovarian cancer (n = 3). The trial was stopped because of excess morbidity in the form of streptococcal septic shock in the group not receiving gram-positive prophylaxis. There were significantly fewer overall infections (10 versus 3; P = 0.016) and streptococcal infections (9 versus 1; P = 0.0078) in the group receiving gram-positive prophylaxis. There were no significant differences in the numbers of deaths, duration of broad-spectrum antibiotics, or incidence of neutropenic fever between the two groups. Prophylaxis for gram-positive infections with penicillin or vancomycin is effective in reducing the incidence of streptococcal infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplant. However, this approach may carry a risk of fostering resistance among streptococci to penicillin or vancomycin.

Topics: Acyclovir; Adult; Bacteremia; Bone Marrow Transplantation; Female; Fever; Fluconazole; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Neoplasms; Norfloxacin; Penicillins; Premedication; Streptococcal Infections; Vancomycin

Topics: Acyclovir; Bone Marrow Transplantation; Clinical Trials as Topic; Double-Blind Method; Humans; Postoperative Complications; Random Allocation; Sepsis; Streptococcal Infections

Twenty-eight patients with upper extremity infections and positive for the human immunodeficiency virus (HIV) were identified. The risk factor for HIV infection was intravenous drug injection in 24 patients, homosexual contact in 3, and heterosexual contact in 1. Eight of the patients had the acquired immunodeficiency syndrome. Two of the cases were prolonged herpetic infections of more than 6 months' duration that did not respond to oral acyclovir. The other 26 cases were bacterial in origin. Twenty-six of 28 cases responded to therapy with resolution of the infection. One patient refused surgical treatment and one died of systemic illness before resolution of the hand infection.

Topics: Abscess; Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Arm; Cause of Death; Cohort Studies; Drug Resistance, Microbial; Female; Hand; Herpes Simplex; Heterosexuality; HIV Infections; Homosexuality, Male; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Sepsis; Soft Tissue Infections; Staphylococcal Infections; Streptococcal Infections; Substance Abuse, Intravenous

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Fasciitis, Necrotizing; Humans; Musculoskeletal Diseases; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Vaccination

Topics: Acyclovir; Anti-Bacterial Agents; Diagnosis, Differential; Female; Herpes Genitalis; Herpes Simplex; Humans; Infant, Newborn; Male; Obstetric Labor Complications; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Sepsis; Streptococcal Infections; Streptococcus agalactiae