trimethoprim--sulfamethoxazole-drug-combination and Lymphoma

Pneumocystis jiroveci pneumonia (PCP) is frequently reported in lymphoma patients treated with rituximab-contained regimens. There is a trend toward a difference in PCP risk between bi- and tri-weekly regimens. The aims of this systemic review and meta-analysis were to estimate the risk for PCP in these patients, compare the impact of different regimens on the risk, and evaluate the efficacy of prophylaxis. The cohort studies with incept up to January 2014 were retrieved from the Cochrane Library, Medline, Embase, and Web of Science databases. Studies that compared the incidence of PCP in patients with and without rituximab treatment were conducted. Studies that reported the results of prophylaxis were concentrated to evaluate the efficacy of prophylaxis. Fixed effect Mantel-Haenszel model was chosen as the main analysis method. Funnel plots were examined to estimate the potential selection bias. Egger's test and Begg's test were used for the determination of possible small study bias. Eleven cohort studies that met the inclusion criteria were finally included. Results indicated that rituximab was associated with a significantly increased risk for PCP (28/942 vs 5/977; risk ratio: 3.65; 95% confidence interval 1.65 to 8.07; P=0.001), and no heterogeneity existed between different studies (I2=0%). Little significant difference in PCP risk was found between bi-weekly and tri-weekly regimens (risk ratio: 3.11; 95% confidence interval 0.92 to 10.52, P=0.068). PCP risk was inversely associated with prophylaxis in patients treated with rituximab (0/222 vs 26/986; risk ratio: 0.28; 95% confidence interval 0.09 to 0.94; P=0.039). In conclusion, PCP risk was increased significantly in lymphoma patients subjected to rituximab-contained chemotherapies. Difference in PCP risk between bi-weekly and tri-weekly regimens was not significant. Additionally, prophylaxis was dramatically effective in preventing PCP in rituximab-received lymphoma patients, suggesting that rituximab should be recommended for these patients.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Incidence; Lymphoma; Odds Ratio; Pneumocystis carinii; Pneumonia, Pneumocystis; Publication Bias; Rituximab; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

At present, there is strong concern about the efficacy of current antimicrobial prophylaxis for the management of neutropenic patients. The purpose of this study was to test the effectiveness of levofloxacin, a new quinolone with expanded activity against grampositive bacteria, versus cotrimoxazol as a prophylactic treatment for granulocytopenic patients.. In this prospective and controlled study, we included 249 consecutive episodes of neutropenia, such as those resulting from lymphoma and leukemia treatment, during 28 months (from November 1999 to February 2002). These episodes were divided into 3 cohorts: the first was treated with levofloxacin, the second with cotrimoxazol and the third was a subgroup without antibiotic prophylaxis (control group). The incidence of infection, rate of mortality, and reduction of hospitalization rate for treatment with parenteral antibiotics were tested.. There was a reduction in documented infections (clinically or microbiologically) when comparing the levofloxacin cohort with the control cohort (p < 0.0001) and the levofloxacin cohort with the cotrimoxazol group (p < 0.01). The reduction in the hospitalization rate for treatment with parenteral antibiotics reached statistical significance when comparing the levofloxacin group with the control cohort (p < 0.001) and levofloxacin group with the cotrimoxazol group (p < 0.05). Although the rate of global mortality was lower in the levofloxacin group than in the other two groups, no statistical significance was observed.. Our results show that levofloxacin effectively reduces the incidence of infection, the rate of hospitalization and the requirement for parenteral antibiotics. Although we found a reduction in the overall mortality and in the infection-related mortality, the corresponding data did not reach statistical significance.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Leukemia; Levofloxacin; Lymphoma; Middle Aged; Neutropenia; Ofloxacin; Opportunistic Infections; Prospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred and thirty-nine consecutive episodes of fever were evaluated in 55 patients with hematological disorders during persistent neutropenia. In 121 instances, patients were given trimethoprim-sulfamethoxazole + amikacin (TMP/SMZ + AMI) as an initial antibiotic regimen with clinical success in 51% (i.e. antibiotic treatment was not changed within the first 7 days). Imipenem/cilastatin (I/C) therapy was instituted in: (a) 22 episodes with clinical failure and fever of unknown origin during TMP/SMZ + AMI therapy and (b) 18 episodes with a second fever episode during initially successful TMP/SMZ + AMI therapy. The response rate for all 40 I/C treated episodes was 80%. One neutropenic patient in the whole series died from infectious complications within four weeks from institution of therapy. TMP/SMZ+AMI seems to be a safe and inexpensive "standard" antibiotic regimen in neutropenic patients. I/C appears to have good efficacy when used as secondary therapy after failure with TMP/SMZ+AMI.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Bacterial Infections; Bone Marrow Transplantation; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Fever; Hematologic Diseases; Humans; Imipenem; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Pneumocystis Infections; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

In an attempt to reduce the incidence of fever and infection, we randomized patients with cancer to receive trimethoprim/sulfamethoxazole plus erythromycin (TMP/SMX + E) versus placebos after each cycle of chemotherapy (no crossover) and to continue until granulocytopenia (polymorphonuclear leukocytes less than 500/mm3) resolved or the patient became febrile. We evaluated 541 episodes (150 patients); 249 episodes (77 patients) with TMP/SMX + E and 292 episodes (73 patients) with placebos. The patients' median age was 17 years. Thirty percent of the patients had leukemia, 23% had lymphoma, and 47% had solid tumors. Compliance with prescribed medication was prospectively rated as excellent in 60.6%, good in 11.7%, poor in 11.1%, and unknown in 16.6%; compliance was better for the placebo group (P = 0.001). The overall incidence of fever or infection was 22.1% for the TMP/SMX + E group versus 26.9% for the placebo group. When only episodes with excellent compliance in which granulocytopenia was documented were compared, the incidence of fever or infection was 18.1% for the TMP/SMX + E group vs 32.2% for the placebo group (P = 0.009), with bacterial infection occurring in 3.8% of the TMP/SMX + E group vs 11.9% of the placebo group (P = 0.019), and unexplained fever in 10.5% of the TMP/SMX + E group vs 19.6% of the placebo group (P = 0.037). Patients with good or poor compliance showed no significant benefit from the TMP/SMX + E, and patients with excellent compliance did best, regardless of whether they were receiving antibiotics or placebos, suggesting that patient compliance is an important independent variable. The incidence of fever or infection was significantly lower for patients with leukemia with excellent compliance who received antibiotics (P = 0.037) than for patients with lymphomas or solid tumors. Oral antibiotic prophylaxis reduced the incidence of fever and infection in some granulocytopenic patients, but the benefit was limited and restricted to patients whose compliance was complete.

Topics: Adolescent; Adult; Agranulocytosis; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Erythromycin; Female; Fever; Humans; Infant; Leukemia; Lymphoma; Male; Neoplasms; Patient Compliance; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Agranulocytosis; Child; Clinical Trials as Topic; Drug Combinations; Fever; Humans; Infection Control; Infections; Leukemia; Lymphoma; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Antineoplastic Agents; Humans; Immunocompromised Host; Lymphoma; Male; Mycetoma; Nocardia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Atrial Fibrillation; Ceftriaxone; Cell Transformation, Neoplastic; Coronary Artery Disease; Diagnosis, Differential; Humans; Hyperlipidemias; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma; Male; Middle Aged; Neoplasm Recurrence, Local; Nocardia Infections; Seizures; Smoking; Trimethoprim, Sulfamethoxazole Drug Combination

This study was conducted to determine the efficacy of dosing trimethoprim/sulfamethoxazole on 2 consecutive days per week for the prevention of Pneumocystis carinii (jiroveci) pneumonia in a pediatric leukemia and lymphoma population and to determine whether trimethoprim/sulfamethoxazole contributes to neutropenia during maintenance therapy.. Charts were reviewed for all pediatric patients with leukemia and lymphoma diagnosed between January 1, 1993, and December 31, 2002. Data were collected through April 1, 2004.. A total of 575 charts were reviewed; 529 patients were included in the analysis. A total of 482 (345 leukemia, 137 lymphoma) patients were evaluated on trimethoprim/sulfamethoxazole dosed 2 consecutive days per week for 268074 patient-days. No breakthrough cases were documented in compliant patients; 2 noncompliant patients developed P. carinii pneumonia. A total of 238 patients who were on trimethoprim/sulfamethoxazole prophylaxis and 13 patients who were receiving an alternative medication prophylaxis were evaluated for neutropenia during maintenance therapy. The median number of maintenance days on trimethoprim/sulfamethoxazole was 605.5 days and on alternative drug was 617 days. The median number of neutropenic maintenance days on trimethoprim/sulfamethoxazole was 15.5 days and on the alternative drug was 16 days. The median proportion of neutropenic days per patient was 0.029 on trimethoprim/sulfamethoxazole and 0.022 on the alternative drug.. Intermittent dosing of trimethoprim/sulfamethoxazole on 2 consecutive days per week is an effective alternative prophylactic regimen for P. carinii pneumonia in pediatric patients with leukemia and lymphoma. This analysis does not support a difference in neutropenia during maintenance therapy between patients who are treated with trimethoprim/sulfamethoxazole versus an alternative drug.

Topics: Anti-Infective Agents; Child; Drug Administration Schedule; Humans; Leukemia; Lymphoma; Neutropenia; Opportunistic Infections; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

(i) To compare the prevalence and levels of Capnocytophaga, a known systemic pathogen in immunocompromised patients, in the dental plaque of healthy children and children with cancer, and (ii) to determine the susceptibility of strains isolated from cancer patients to a range of antibiotics.. Thirty-one children with cancer undergoing a first course of immunosuppressive chemotherapy and 30 healthy control children were included in the study. Samples were collected on days 0, 7, 14, and 21 of the cure (and equivalent dates in controls). Susceptibility to antibiotics was tested using an agar dilution method and galleries with predefined concentrations of selected antibiotics.. There was a significant drop in the total anaerobic cultivable flora on day 14 and in the prevalence of Capnocytophaga on days 14 and 21 in the children with cancer. The proportion of Capnocytophaga in the anaerobic flora, however, was high in certain cancer patients. Beta-lactam/beta-lactamase inhibitor combinations, imipenem, clindamycin, and tetracycline were the most effective against Capnocytophaga.. This study showed that Capnocytophaga decreased in prevalence and proportion in the dental plaque of cancer patients during chemotherapy but became predominant in some cases. It is recommended that imipenem or beta-lactam/beta-lactamase inhibitor combinations be used to treat Capnocytophaga bacteraemia.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents; Capnocytophaga; Case-Control Studies; Chi-Square Distribution; Child; Child, Preschool; Colony Count, Microbial; Dental Plaque; Drug Resistance; Female; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lymphoma; Male; Microbial Sensitivity Tests; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Statistics, Nonparametric; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a rare, generalized inflammatory disorder due to the recently described bacterium Tropheryma whippelii. We report an unusual, successfully treated case of a 32-year-old woman, who presented with a 25 month history of large abdominal lymphomas, polyserositis and cachexia. The diagnosis of Whipple's disease was confirmed by duodenoscopy, lymph node and duodenal histology and polymerase chain reaction analysis of biopsy material and cerebrospinal fluid. A prolonged convulsive seizure with a subsequent 5 day period of coma were interpreted as signs of cerebral involvement. Under antibiotic treatment with trimethoprim-sulfamethoxazole (co-trimoxazole) the patient recovered completely, CT scans showed a complete regression of abdominal lymphomas. The therapy was continued over 18 months without the occurrence of a relapse.

Topics: Abdominal Neoplasms; Adult; Anti-Infective Agents; Brain Diseases; Coma; Female; Humans; Lymphoma; Seizures; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

Topics: Drug Therapy, Combination; Empyema; Humans; Imipenem; Lung Diseases; Lung Neoplasms; Lymphoma; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Stomach Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Waldenstrom Macroglobulinemia

Between 1976 and 1983, 53 cases of Pneumocystis carinii pneumonia were documented at the Mayo Clinic. Underlying diseases included leukemia in 15 patients, lymphoma in nine, nonhematologic malignancies in five, acquired immune deficiency syndrome in two, an various inflammatory diseases treated by corticosteroids in 16 patients. Cytotoxic drugs with corticosteroids were used in 68 percent of patients, whereas 23 percent received corticosteroids alone. Clinical features consisted of progressive dyspnea (74 percent), cough (55 percent), and fever (62 percent), with normal findings on examination (43 percent), or crackles (53 percent). Arterial oxygen tension and oxygen saturation were 48.6 +/- 12.8 mm Hg and 81.2 +/- 6.5 percent, respectively. Chest roentgenographs exhibited diffuse alveolar and interstitial infiltrates with predominantly perihilar distribution. The diagnostic rates for open lung biopsy and bronchoscopy were 97 percent and 62 percent, respectively. Clinical improvement and survival following appropriate therapy were noted in 22 patients (41.5 percent), whereas the remaining 31 patients died within four weeks of hospitalization. When survivors were compared with nonsurvivors, there was no difference in mean age, leukocyte counts, arterial oxygen tension, or duration of symptoms before treatment. A coexisting pulmonary infection was identified more frequently in nonsurvivors (51.6 percent) than in survivors (22.7 percent, p = 0.01). The mortality from P. carinii pneumonia alone was 47 percent, whereas 76 percent of those with coexisting infection died. Despite antibiotic therapy and potentially effective chemoprophylaxis, P. carinii pneumonia remains a significant and life-threatening complication of diseases or treatments associated with immune suppression.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Cortex Hormones; Drug Combinations; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neoplasms; Pentamidine; Pneumonia, Pneumocystis; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Agranulocytosis; Bacterial Infections; Drug Combinations; Drug Therapy, Combination; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Sulfamethoxazole; Tobramycin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

Topics: Abscess; Drug Combinations; Humans; Japan; Lymphoma; Male; Middle Aged; Minocycline; Nocardia Infections; Skin Diseases, Infectious; Sulfamethoxazole; T-Lymphocytes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Continuous infusion of amikacin, cotrimoxazole and carbenicillin was the second empirically established combination of antibiotics used when fever occurred during the induction phase of chemotherapy in sixty-five patients (58 acute myeloid leukemias, 5 acute lymphoid leukemias, 2 non Hodgkin lymphomas). Clinical evidence of infection was available in 25 cases and the infection was bacteriologically documented in 19 cases. Therapy was successful in 57 patients (89%). When infection was clinically or bacteriologically documented tha success rates were 92 and 82% respectively. The average length of treatment was ten days. In 25 patients receiving 2 g of amikacin in continuous infusion, the mean serum concentration was 15,9 micrograms/ml; in 17 patients receiving 3 g, the mean serum concentration was 19,4 micrograms/ml.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Bacterial Infections; Carbenicillin; Drug Combinations; Drug Therapy, Combination; Female; Fever; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphoma; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination