nystatin-a1 and Leukemia--Myeloid--Acute

The goal of reducing oral complications during chemotherapy and bone marrow transplantation has received attention at several centers. The current randomized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation assessed the potential role of chlorhexidine, nystatin, and saline solution rinses to reduce the findings of oral mucositis, gingivitis, and oral infection. The results of this study did not show a reduction in mucositis with the use of these rinses. However, potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Bacteremia; Bacteria; Bone Marrow Transplantation; Candidiasis, Oral; Chlorhexidine; Drug Combinations; Female; Humans; Leukemia; Leukemia, Myeloid, Acute; Male; Middle Aged; Mouth Diseases; Mouthwashes; Nystatin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stomatitis; Ulcer; Whole-Body Irradiation

Topics: Bacterial Infections; Clinical Trials as Topic; Drug Evaluation; Drug Therapy, Combination; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Nystatin; Sulfamethoxazole; Trimethoprim

30 patients with acute leukaemia being treated with cytotoxic drugs were investigated in a randomised trial to determine whether oral administration of co-trimoxazole in addition to non-absorbable antibiotics would reduce the rate of infection. Three significant differences were observed between the co-trmoxazole and the control groups: (i) 15 of the 16 (94%) control patients but only 8 of the 14 (57%) patients on co-trimoxazole developed infections and required additional antibiotics intravenously; (ii) although the duration of severe neutropenia (neutrophils less than 0.1 times 10(9)/1) was similar in the two groups, control patients required intravenous antibiotics on average after 2 days of neutropenia, whereas patients receiving co-trimoxazole required these only after 12 days; and (iii) the only 2 patients who died of infection were in the control group. Prophylaxis with co-trimoxazole is important in preventing or delaying the development of infection in neutropenic patients receiving therapy for acute leukaemia.

Topics: Administration, Oral; Adolescent; Adult; Aged; Clinical Trials as Topic; Colistin; Cross Infection; Drug Combinations; Drug Therapy, Combination; Framycetin; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Middle Aged; Neutropenia; Nystatin; Prospective Studies; Research Design; Sulfamethoxazole; Trimethoprim

Fifty-six untreated patients with acute leukemia (38 acute myelogenous leukemia, 16 acute lymphoblastic leukemia, and 2 blast crisis of chronic granulocytic leukemia) were randomized on admission to one of three groups--one to receive oral anticandidal prophylaxis through the period of remission induction chemotherapy with nystatin, another to receive natamycin, and the third to receive no anticandidal prophylaxis. Neither of the first two groups show any advantage over the last and it is concluded that provided gut sterilization regimes are not employed, prophylactic oral anticandidal treatment is of no value in these patients and should be reserved until there is clinical evidence of infection.

Topics: Administration, Oral; Antineoplastic Agents; Candidiasis; Candidiasis, Oral; Drug Evaluation; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Natamycin; Nystatin

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Gentamicins; Hemorrhage; Humans; Infection Control; Leukemia, Myeloid, Acute; Middle Aged; Nystatin; Patient Isolators; Prospective Studies; Pseudomonas Infections; Remission, Spontaneous; Respiratory Tract Infections; Vancomycin

Thirty-four patients with haematological malignancies were studied to investigate the effect of empirical broad-spectrum antibiotic therapy (ceftazidime and gentamicin) on the gastro-intestinal flora. Twenty-five patients with acute myeloid leukaemia or post-autologous bone-marrow transplantation were given framycetin, nystatin and colistin (Fracon), and two patients with non-Hodgkin's Lymphoma were on co-trimoxazole, as long-term gut prophylaxis. Semi-quantitative microbiology was carried out on oropharyngeal swabs and quantitative microbiology on faecal specimens. The oropharyngeal flora consisted mainly of streptococci, coagulase-negative staphylococci and coryneforms, and was little affected by ceftazidime/gentamicin. A strain of Enterobacter cloacae resistant to ceftazidime and gentamicin colonized one patient, who later developed septicaemia. The faecal flora of patients on Fracon was dominated by enterococci; the few enterobacteria present were eliminated by ceftazidime/gentamicin. The anaerobic flora was absent in 15% of patients; in the remainder, it consisted mainly of Bacteroides spp., and was little affected by ceftazidime/gentamicin. The faecal flora of patients not on Fracon always contained anaerobes, and some strains of enterobacteria persisted throughout antibiotic treatment. None of the patients was colonized by Clostridium difficile or Pseudomonas aeruginosa. Broad-spectrum therapy with ceftazidime and gentamicin appeared to have little effect on the gastro-intestinal flora, except to encourage the overgrowth of enterococci and reduce the numbers of enterobacteria.

Topics: Ceftazidime; Colistin; Enterobacter; Feces; Gentamicins; Humans; Leukemia, Myeloid, Acute; Lymphoma, Non-Hodgkin; Neutropenia; Nystatin; Oropharynx; Risk Factors; Staphylococcus; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination

Opportunistic mycotic infections have a significant influence on the morbidity and mortality of children whose immune systems are depressed by the onset of AML. The present paper assesses the incidence of the pathogenic mycotic flora and the in vitro efficacy of the main antimycotic drugs. Candida was che most commonly encountered pathogen and its in vitro response to the polyenic antibiotics was good.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Child; Clotrimazole; Drug Resistance, Microbial; Female; Flucytosine; Humans; Ketoconazole; Leukemia, Myeloid, Acute; Male; Miconazole; Nystatin

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 result documenting the disappearance of obligate anaerobic bacteria as the predominant intestinal organisms with the onset of septicemia from S. marcescens calls for exploration into the clinical significance of anaerobic bacteria in the intestine in relationships between gut flora and host. The finding that no significant difference could be seen between the rates of septicemia under protective isolation and in uncontrolled environments is indicative of the fact that the disease most likely originated as an infection of endogenous nature. In the five cases of leukemia in children with bone marrow transplantation cited in this presentation, not one case of bacterial or fungal infection was recorded. The establishment of endogenous infections surrounding the results presented herein is discussed in terms of the biological phenomena of the interaction between intestinal flora and host, and between the intestinal bacterial flora.

Topics: Adolescent; Aged; Bacteria, Anaerobic; Bacterial Infections; Bone Marrow Transplantation; Child; Digestive System; Environment, Controlled; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Nystatin; Polymyxin B; Serratia marcescens; Vancomycin

Topics: Adrenal Cortex Hormones; Bacitracin; Blood Transfusion; Calcium; Digitalis Glycosides; Diuretics; Humans; Hypocalcemia; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neomycin; Nystatin; Potassium; Retrospective Studies; Serum Albumin; Tetany

Faecal volatile fatty acids represent the end products of the metabolism of the anaerobic flora of the large bowel. The excretion of these volatile acids has been investigated in five leukaemic patients maintained in plastic ;germ-free' isolators. Under ;isolator' conditions there is a pronounced fall in volatile fatty acid excretion. The possibility that the measurement of these acids may be used to monitor anaerobic overgrowth and recolonization in these patients is discussed.

Topics: Adult; Chromatography, Gas; Colistin; Fatty Acids, Volatile; Feces; Female; Gentamicins; Humans; Intestine, Large; Leukemia, Monocytic, Acute; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Middle Aged; Nystatin; Patient Isolators; Propionates; Vancomycin