nystatin-a1 and Anemia--Aplastic

Candida overgrowth and invasion constitute a serious threat with a high mortality in BMT recipients. Currently available topical antifungal prophylaxis is largely ineffective, and as resistance to existing, absorbable drugs for systemic use is rapidly developing, new forms of therapy are needed. We investigated the effect of oral treatment of BMT recipients with a bovine immunoglobulin product derived from animals immunized against several Candida species. The natural Candida colonization was first followed in 19 patients to establish the colonization pattern. Half of the patients were found to be colonized prior to transplantation and altogether 72% were colonized at some point during follow-up. Those with a high pre-transplant concentration of Candida in saliva (>100 CFU/ml) remained colonized throughout the BMT treatment period. The therapeutic effect was monitored in two other patient groups. The first group consisted of nine patients, where, due to a low number of primary colonized patients, response in colonized patients was suggestive of a therapeutic effect. In the second group, 10 patients with a high level of colonization (>100 CFU/ml) were given 10 g daily of the product in three divided doses. The results suggest a treatment-related reduction in Candida colonization in a majority (7/10) of patients and one patient became completely negative. As no adverse effects were noted, our findings encourage additional studies in immunocompromised, transplant patients.

Topics: Administration, Oral; Adolescent; Adult; Anemia, Aplastic; Animals; Antibodies, Fungal; Antifungal Agents; Bone Marrow Transplantation; Candida albicans; Candidiasis; Cattle; Child; Colostrum; Female; Hematologic Neoplasms; Humans; Immunization, Passive; Immunocompromised Host; Intestinal Absorption; Male; Middle Aged; Mouth; Nystatin; Opportunistic Infections; Pharmacokinetics; Saliva; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome

Invasive aspergillosis seems to be on the rise, especially in immunocompromised children. Historically, only systemic amphotericin B has been effective against Aspergillus. Development of newer antifungal agents, such as voriconazole and caspofungin, has improved the treatment options available for aspergillosis, although no definitive management strategy has been established. Here we describe the use of topical voriconazole combined with systemic antifungal agents for cutaneous aspergillosis in a pediatric patient after bone marrow transplant.

Topics: Administration, Cutaneous; Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Disease Susceptibility; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Injections, Subcutaneous; Nystatin; Postoperative Complications; Pyrimidines; Skin; Transplantation, Homologous; Triazoles; Voriconazole

Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.

Topics: Acyclovir; Adolescent; Adult; Amphotericin B; Anemia, Aplastic; Bone Marrow Transplantation; Child; Cyclophosphamide; Etoposide; Female; Graft Survival; Graft vs Host Disease; Herpes Genitalis; HLA Antigens; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Methotrexate; Middle Aged; Nystatin; Prednisolone; Tissue Donors; Whole-Body Irradiation

The effect of a multi-agent regimen on oropharyngeal candidiasis (OPC) prophylaxis in 16 consecutive pediatric bone marrow transplant patients was assessed. The multi-agent regimen consisted of: 1) debriding all mucous membrane surfaces within the oropharyngeal cavity with povidone-iodine 4 times a day, 2) swabbing all mucous membrane surfaces within the oropharyngeal cavity with nystatin 4 times a day, and 3) Ketoconazole given daily by mouth. Multi-agent regimen therapy was initiated on the day marrow ablative therapy began, and was terminated when the patient's absolute neutrophil count recovered to above 500/mm3. Baseline oropharyngeal fungal cultures indicated that 8 out of 16 (50%) of the patients were Candida carriers. Subsequent surveillance cultures indicated that 13 out of 16 (81.3%) of the patients had negative oropharyngeal fungal cultures during the entire period they were on the multi-agent regimen. The remaining three patients had negative oropharyngeal fungal cultures by the end of the experimental period. None of the patients developed Candida esophagitis or sepsis. The above regimen is an effective and non-toxic method to prevent oropharyngeal candidiasis in pediatric BMT patients.

Topics: Adolescent; Anemia, Aplastic; Bone Marrow Transplantation; Burkitt Lymphoma; Candidiasis; Child; Child, Preschool; Female; Humans; Infant; Ketoconazole; Leukemia; Leukemia, Lymphoid; Male; Mouth Diseases; Neuroblastoma; Nystatin; Pharyngeal Diseases; Povidone-Iodine; Transplantation, Autologous; Transplantation, Homologous

Topics: Acute Disease; Administration, Oral; Anemia, Aplastic; Bacterial Infections; Bone Marrow Transplantation; Drug Therapy, Combination; Humans; Intestines; Leukemia; Nystatin; Premedication; Tobramycin; Vancomycin

Topics: Adult; Anemia, Aplastic; Colistin; Drug Therapy, Combination; Framycetin; Humans; Male; Neutropenia; Nystatin; Rectal Fistula; Rectum; Sterilization