SUPPORTIVE CARE OF CHILDREN WITH CANCER: PROPHYLAXIS AGAINST FUNGI


Fungal infections are a significant cause of morbidity and mortality in immune-suppressed patients undergoing prolonged periods of antibiotic therapy for fever/neutropenia. The most common fungal infections in patients receiving intensive chemotherapy include candidiasis and aspergillosis.

A. Candidiasis

Candidiasis is the most common fungal infection in children receiving anticancer therapy.

For prevention of oral or esophageal candidiasis during treatment with steroids or with intensive chemotherapy, use either of the following regimens:

a. Mycostatin oral swish and swallow (5-10 mL b.i.d.).

b. Clotrimazole troche (1 b.i.d. suck for 20 minutes).

B. Aspergillosis

Aspergillus is primarily an airborne organism. Sino-pulmonary colonization is thought to precede infection.

Aspergillus infection may be avoided as follows:

a.     Efforts to prevent aspergillus infection should include

respiratory isolation, use of laminar flow rooms, and

use of high-efficiency particulate air filters.

b. If the patient is hospitalized at an institution where

aspergillus infections are common, consider eliminating plants from the patient's room, monitoring and

controlling nasal microbial flora, and scrutinizing construction work (which may be a source of airborne aspergillus spores).

c. Low-dose amphotericin B (0.1-0.25 mg/kg/day IV) or

the inhalant form of amphotericin B may reduce the incidence of invasive aspergillosis. Itraconazole and other agents need to be further evaluated.

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Cancer

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