nystatin-a1 and Lymphoma--Non-Hodgkin

We evaluated the efficacy and toxicity of ketoconazole versus nystatin antimycotic prophylaxis in a prospective randomized study of 32 patients receiving intensive weekly outpatient combination chemotherapy for non-Hodgkin's lymphoma with crossover to the other drug if failure occurred. Thirteen patients were assigned to nystatin and 19 to ketoconazole. Fungal infections occurred in three patients receiving nystatin (16%) and one patient receiving ketoconazole (8%); one patient refused his assigned drug due to taste intolerance. Including the crossover courses of drug, the failure rate associated with ketoconazole was 6% while that for nystatin was 20% (p = 0.23). We favor ketoconazole as antifungal prophylaxis during antilymphoma chemotherapy because of at least equivalent and possibly superior efficacy, better acceptance by patients, easier administration, and systemic absorption.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Female; Humans; Ketoconazole; Leucovorin; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Mycoses; Nystatin; Prednisone; Prospective Studies; Random Allocation; Time Factors; Vincristine

Fifty-eight patients with malignant lymphoma were randomly allocated to receive three courses of chemotherapy to induce remission with CHOP-Bleo on the protected environment-prophylactic antibiotic (PEPA) program (30 patients) or as controls (28 patients). The complete remission rate for all patients was 74 per cent, for patients with diffuse histiocytic lymphoma 78 per cent and for patients with nodular poorly differentiated lymphocytic lymphoma 65 per cent. There were no significant differences in response rates and duration of responses between those on the PEPA program and control patients. The frequency of infection was significantly lower among the patients on the PEPA program, and dosage escalation of the chemotherapeutic agents was accomplished more often among these patients. Dosage escalation did not increase the complete remission rate, but it did reduce the relapse rate and signficantly reduced the fatality rate. The duration of remission and survival was significantly longer for those patients who received dosage escalation.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Bleomycin; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Gentamicins; Humans; Immunosuppression Therapy; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Middle Aged; Nystatin; Patient Isolation; Prednisone; Vancomycin; Vincristine

Though oral candidosis is an opportunistic fungal infection that commonly affects immunocompromised patients, little is known of its occurrence as a complication of Non-Hodgkin's lymphoma. This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans. A culture from a saline rinse was also positive for multiple candidal colonies. Lip and oral lesions were managed with Nystatin. The lesions regressed with subsequent crusting on the lips, and overall reduction in oral thrush. As Non-Hodgkin's lymphoma is a neoplastic disease that produces a chronic immunosuppressive state, management of its oral complications, including those due to oral candidosis, is considered a long-term indication.

Topics: Adult; Antifungal Agents; Candidiasis, Oral; Female; Humans; Immunocompromised Host; Lymphoma, Non-Hodgkin; Nystatin

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

Gastrointestinal Candida infection is more prevalent than previously recognized. It is most often seen in patients with underlying impairment of the immune system but may also occur in apparently normal individuals. Esophageal involvement is most common, presenting with odynophagia, dysphagia, or bleeding. Gastric Candida infection may cause diffuse mucosal involvement or focal invasion of benign gastric ulcers. Intestinal candidiasis is uncommon and poorly characterized. The diagnosis is usually established by visualizing the characteristic yeast or mycelial forms in endoscopic brushings and biopsies. Oral nystatin is effective therapy in many patients, but other antifungal agents may be needed in extensive or persistent disease, especially in immunocompromised patients.

Topics: Candidiasis; Deglutition Disorders; Diagnosis, Differential; Esophageal Diseases; Flucytosine; Humans; Imidazoles; Intestinal Diseases; Leukemia; Lymphoma; Lymphoma, Non-Hodgkin; Nystatin; Polyenes; Stomach Diseases