Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients

Article Abstract:

Bacteremia (the presence of bacteria in the blood) is common in cancer patients with granulocytopenia, an abnormally low number of the type of white blood cells called granulocytes. The incidence of bacteremia caused by gram-positive bacteria (bacteria that appear purple when stained with Gram stain) has increased over the last decade. The conventional antibiotics (aminoglycosides, penicillins and cephalosporins) used for treating bacteremia caused by gram-negative bacteria are not always effective in treating patients with bacteremia due to gram-positive bacteria. Therefore, a clinical drug trial was designed to test the effectiveness of vancomycin in treating gram-positive bacteremia. The drug trial included 747 cancer patients with granulocytopenia who were treated with a combination of ceftazidime and amikacin (CA), with or without vancomycin (V). Of the 747 patients, 135 had bacteremia caused by gram-positive bacteria. The gram-positive bacteremia was treated successfully in 43 percent of the patients given CA and in 72 percent of those given CA and V. However, the number of patients with fever and the duration of the fever caused by the bacteremia were the same for both treatment groups, regardless of the addition of V. There were no deaths due to the bacteremia in either treatment group. The incidence of kidney toxicity was higher in the group treated with V (6 percent) than in the group that did not receive V (2 percent). The results of this study indicate that V is successful in treating gram-positive bacteremia in granulocytopenic cancer patients who do not respond to treatment with conventional antibiotics; however, vancomycin should not be used routinely in the initial antibiotic regimen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Complications and side effects, Vancomycin, Cancer patients, Drug therapy, Combination, Combination drug therapy, Bacteremia, Granulocytopenia

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Challenges facing antimalarial therapy in Africa

Article Abstract:

Malaria is one of the most common diseases in Africa south of the Sahara. It is caused by the microorganism Plasmodium falciparum (P. falciparum), which infects red blood cells. The disease is transmitted by the bite of an infected female mosquito. Approximately 300 to 500 million episodes of malaria are treated each year in this region. Severe forms of the disease cause anemia (abnormally low numbers of red blood cells) and damage the kidneys, lungs, nerves and brain. Cerebral malaria (which affects the brain) can result in death within 36 to 48 hours of infection; it is estimated to cause 1 to 2 million deaths each year in Africa. The greatest number of deaths occur in children between one and four years of age. Chloroquine was among the first and most widely prescribed drugs for the treatment of malaria. However, over the last three decades P. falciparum has become resistant to chloroquine (that is, it is no longer killed by the drug). This resistance has spread throughout all areas of Africa south of the Sahara. The development of new drugs for treating malaria is a slow process. Over the last 10 years, only two new drugs (mefloquine and halofantrine) have been approved for use in treating patients with malaria. There are two major obstacles that hinder the development of new antimalarial drugs. The first is the lack of scientific knowledge about the biochemistry and genetics of P. falciparum, and the second is the fact there is little financial motivation (profit) for drug companies to develop drugs for treating diseases that occur in one of the poorest areas of the world. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Pharmaceutical industry, Developing countries, Africa, Malaria

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