Infectious disease management of adult leukemic patients undergoing chemotherapy: 1982 to 1986 experience at Stanford University Hospital

Article Abstract:

Current chemotherapy protocols have improved the prognosis of leukemia in adults to a 50 to 80 percent complete remission rate. Chemotherapeutic agents have a tendency to deplete white blood cells which fight off infection, placing patients at high risk of infection from bacteria and fungi. In fact, infection-related complications are the leading cause of death in patients receiving chemotherapy. Catheters, indwelling tubes placed under the skin to deliver chemotherapy (medications) directly into the blood, are a major source of infection. The incidence of infections and the use of antibiotics in patients receiving chemotherapy for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) were reviewed in one hospital between 1982 and 1986. A total of 142 patients received 226 courses of chemotherapy; 190 of the patients required antibiotics. When chemotherapy patients were suspected of having infection, antibiotics were administered during the first five days of hospitalization and continued until the white blood cell count was satisfactory (indicating resolution of the infection). Infections were confirmed in 37 percent of the patients. Bacteria was responsible for 93 percent of the infections, most of which were acquired by the use of indwelling catheters. Viruses accounted for four percent of the infections, and three percent were attributed to fungal infections. Most of the deaths were due to toxic antibiotic reactions. Twelve out of 31 patients (39 percent) died from antibiotic-related kidney or liver damage, compared with 12 out of 159 chemotherapy patients (7.5 percent) not using antibiotics. Antibiotics were used excessively and switched often in the treatment of infections during chemotherapy. To improve the management of infections, it is suggested that antibiotic protocols used during chemotherapy be tested to determine the best regimes, adverse reactions and cost-benefit ratios. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Antibiotics, Drug therapy, Bacterial infections, Leukemia

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Decreased phenytoin levels in patients receiving chemotherapy

Article Abstract:

Patients with primary and metastatic brain tumors frequently suffer from seizures. These seizures are treated with phenytoin (dilantin). It has been observed that when some of these patients are treated with chemotherapy, the phenytoin blood level drops below a therapeutic level and seizures occur. To investigate the effect of chemotherapy on phenytoin levels, 19 patients receiving chemotherapy in the form of BCNU (carmustine) and cisplatin were monitored. Data was available for 17 of these patients. All patients receiving BCNU required an increase in their phenytoin dosage; the average increase was 41 percent. Phenytoin levels decreased in 65 percent of all chemotherapy treatment cycles, and in 80 percent of those cycles in which cisplatin was administered. The authors conclude that chemotherapy may lower phenytoin levels significantly, in some cases as early as two days after the beginning of chemotherapy treatments. Patients who require phenytoin to control seizures should be carefully monitored within two or three days after initiation of chemotherapy to assure that their phenytoin levels remain within a specific therapeutic range.

Dosage and administration, Brain tumors, Phenytoin

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