Infections in immunosuppressed and cancer patients – Related resources

Cochrane reviews

• Children appear to be less likely to develop nephrotoxicity with a lipid preparation of amphotericin B compared with conventional amphotericin B used for proven, probable or suspected invasive fungal infections .
• Oral antibiotics are an acceptable alternative to intravenous antibiotics for treating febrile neutropenia in cancer patients at low risk for complications .
• Prophylactic therapy with intravenous amphotericin B may improve prognosis in patients with cancer and neutropenia .
• Empirical anti-Gram-positive antibiotic treatment with glycopeptides (vancomycin, teicoplanin) appears not to improve outcomes in febrile neutropenic cancer patients .
• Antifungal primary prophylaxis with either itraconazole or fluconazole is effective in reducing the incidence of cryptococcal disease in adults with advanced HIV disease .
• Pre-emptive treatment with antiviral agents for solid organ transplant recipients reduces the risk of cytomegalovirus disease when compared to placebo or standard care. The outcomes are similar to routine prophylactic antiviral therapy .
• Evidence is inconclusive to support or refute generalised use of granulocyte transfusions to treat infections in patients with neutropenia caused by chemotherapy .
• Intravenous amphotericin B has documented effect on mortality in cancer patients with neutropenia. There is not sufficient evidence to judge the relative merits of other antifungal agents .
• Ketoconazole may be effective in eradicating oral candidiasis in patients with cancer receiving either chemotherapy or radiotherapy treatment. For clotrimazole, 50 mg dose appears to be more effective than 10 mg dose .
• Prophylactic use of trimethoprim/sulfamethoxazole decreases the occurrence of Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. PCP-related mortality also appears to decrease .
• Flushing the central venous catheter with a combination of vancomycin and heparin appears to reduce the rate of Gram-positive catheter-related infections in oncology patients .
• Prophylactic granulocyte transfusions at a dose of at least 1 x 10¹⁰ seem to be effective in reducing the risk of mortality from infection in patients with neutropenia or neutrophil dysfunction, but there is insufficient evidence from adequate trials .
• Antibiotic prophylaxis reduces all-cause mortality in afebrile neutropenic patients following chemotherapy. The evidence is strongest for quinolones. The addition of gram-positive prophylaxis reduces the incidence of gram-positive bacteraemia .

Other evidence summaries

• Imipenem-cilastatin may be more effective than beta-lactam based regimens for empirically treating febrile neutropenic patients . Antibiotic prophylaxis reduces all-cause mortality in afebrile neutropenic patients following chemotherapy. The evidence is strongest for quinolones. The addition of gram-positive prophylaxis reduces the incidence of gram-positive bacteraemia .

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