Which prophylactic antibacterial therapy apply you to thecpatients with acute leukemia during an induction therapy or to the hematologic patients during a high-dose Chemotherapy and autologous stem cell transplantation?
Commonly used combination is ciprofloxacin (anti-bacterial), an azole (itraconazole, voriconazole...) or ambisome (anti-fungal) and aciclovir (anti-viral).
Siva
It depends on leukemia subtype. In induction (not transplant), for myeloid we prefer the combination: posaconazole (superior), TMP-SMX and acyclovir. For lymphoid fluconazole, TMP-SMX and acyclovir.
We do not always use quinolones it is consider patient by patient. Some guidelines consider TMP-SMX as an option for quinolones.
Dear Dr. Ghanem,
23 years ago Prof. Podbielski (Rostock) teached me, that Group A Streptococci live intracellular. You cannot find them with swab. The paper of Dr. Molinari and Prof. Chhatwal are cited in Nature May 2022.
LaRock, D.L., Johnson, A.F., Wilde, S. et al. Group A Streptococcus induces GSDMA-dependent pyroptosis in keratinocytes. Nature 605, 527–531 (2022). https://doi.org/10.1038/s41586-022-04717-x
2018 Prof. Ferretti (Oklahoma) teached me, that Group A Streptococci are not resistant to Penicillin.
Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2016-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333424/
Best wishes
Yours Friedrich
Dear Abm Saiful Alam,
penicillin is the gold standard against which the third-generation cephalosporins are tested.
At least in neurosyphillis. (1, 2)
Early Penicillin V as prophylaxis (or Penicillin G in sepsis) has to be tested.
To me this seems to be an alternative to Imipemen and Tazobactam.
Ceftriaxone developed high resistance rates in some places. (3)
Best wishes
Yours Friedrich
1. Buitrago-Garcia, D., Martí-Carvajal, A. J., Jimenez, A., Conterno, L. O., & Pardo, R. (2019). Antibiotic therapy for adults with neurosyphilis. The Cochrane database of systematic reviews, 5(5), CD011399. https://doi.org/10.1002/14651858.CD011399.pub2
2. Bettuzzi, T., Jourdes, A., Robineau, O., Alcaraz, I., Manda, V., Molina, J. M., Mehlen, M., Cazanave, C., Tattevin, P., Mensi, S., Terrier, B., Régent, A., Ghosn, J., Charlier, C., Martin-Blondel, G., & Dupin, N. (2021). Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. The Lancet. Infectious diseases, 21(10), 1441–1447. https://doi.org/10.1016/S1473-3099(20)30857-4
3. Salimiyan Rizi, K., Farsiani, H., & Sasan, M. S. (2020). High rate of resistance to ceftriaxone and azithromycin among Shigella spp. isolates at three children's referral hospitals in Northeast Iran. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 26(9), 955–958. https://doi.org/10.1016/j.jiac.2020.04.022
Dear Hosam Ghanem,
O. Landgren found, that Penicillin prevented Chronic Lymphocytic Leukemia. (1)
My patients with AML had recurrent sore throat for many years, before a tumor-clone developed.
Myeloma and CLL are antigen-driven B-Cell-transformations.
I am sure, that Group A Streptococci induced inflammation is a major part of tumor-triggering. (2)
1. Landgren, O., Engels, E. A., Caporaso, N. E., Gridley, G., Mellemkjaer, L., Hemminki, K., Linet, M. S., & Goldin, L. R. (2006). Patterns of autoimmunity and subsequent chronic lymphocytic leukemia in Nordic countries. Blood, 108(1), 292–296. https://doi.org/10.1182/blood-2005-11-4620
2. Mair, F., Erickson, J. R., Frutoso, M., Konecny, A. J., Greene, E., Voillet, V., Maurice, N. J., Rongvaux, A., Dixon, D., Barber, B., Gottardo, R., & Prlic, M. (2022). Extricating human tumour immune alterations from tissue inflammation. Nature, 605(7911), 728–735. https://doi.org/10.1038/s41586-022-04718-w
We use antimicrobials: metronidazole and amoxil/clavulanic acid
antifungal: fluconazole
antiviral: acyclovir
Thanks for your reply Dr. Anazoeze Jude Madu .. I have one Question about the Indikation of Metronidazol in this case? Is it based on microbuologic Statistics in your country?
Dear Dr. Anazoesze Jude Madu,
Dear Dr. Hosam Ghanem,
Amoxicillin/Clavulan kills the microbiom of the gut.
Metronidazol could help to prevent the complication of Clostridium difficile in the gut.
But I think it would be better, to prevent with narrow-spectrum-penicillin.
Best wishes
Yours Friedrich Flachsbart
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