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Biomedical subjects

G P Bodey

Publications and source records attributed to G P Bodey.

At least 145 records · Page 8Linked to original sources
PubMed1990

P&T Committee review of fluconazole: an effective alternative to antifungal therapy.

Fluconazole is a new antifungal agent available in both oral and parenteral formulations. According to the experts in this roundtable discussion, fluconazole represents a major clinical advance in the treatment of candidiasis and cryptococcosis in cancer patients, patients with AIDS, organ transplant recipients, and other patients at risk for opportunistic mycoses. The pharmacokinetic profile for fluconazole permits infrequent dosing and also makes it ideal for tissue site infections. Fluconazole's low toxicity gives it an advantage over currently available antifungal therapy and will permit prompt presumptive treatment of selected infections.

Antifungal Agents↗
PubMed1990

Prophylaxis of candidiasis in cancer patients.

Patients undergoing therapy for metastatic malignancies were randomly assigned to receive fluconazole or placebo as antifungal prophylaxis. Oropharyngeal candidiasis developed in 28% of 54 evaluable patients receiving placebo but in only 2% of 58 evaluable patients receiving fluconazole (P = .0003). Among patients receiving placebo, oropharyngeal candidiasis (thrush) occurred in 30% of those receiving antibiotic therapy and in 44% of those receiving adrenal corticosteroid therapy. Oropharyngeal candidiasis developed in 54% of the placebo patients who were colonized by Candida sp at the onset of prophylaxis. Fluconazole proved to be effective for prophylaxis of oropharyngeal candidiasis in susceptible patients and was well tolerated.

Adolescent↗
PubMed1989

Klebsiella bacteremia. A 10-year review in a cancer institution.

A total of 368 episodes of Klebsiella bacteremia occurred in 330 cancer patients, representing a rate of four episodes per 1000 hospital admissions. Eighty-eight percent of these infections were acquired nosocomically and 58% of the patients received antibiotics during the preceding 10-day period. There was pulmonary infection in 24% of the patients, shock in 25%, and disseminated intravascular coagulation in 7%. The overall response rate was 69%. Response rates were significantly lower among patients with shock (25% versus 83%), hemorrhage (29% versus 76%), and pneumonia (37% versus 79%). The combination of a cephalosporin plus an aminoglycoside produced the highest response rate (79%). Klebsiella sp continue to be an important cause of infection in patients with cancer.

Adolescent↗
PubMed1989

Intravenous ciprofloxacin for infections in cancer patients.

One hundred forty-seven cancer patients were treated with intravenously administered ciprofloxacin, 200 mg every eight hours, as initial therapy for febrile episodes. Thirty patients (20 percent) were neutropenic (less than 1,000 neutrophils/mm3) at the onset of infection. The overall clinical response rate was 78 percent, 73 percent for neutropenic patients and 79 percent for patients with adequate neutrophil counts. Favorable responses were observed in 19 of 25 patients with bacteremia, 29 of 44 patients with pneumonia, 16 of 18 patients with skin and soft-tissue infection, nine of nine patients with urinary tract infection, 10 of 11 patients with upper respiratory infection, and 26 of 34 patients with fever of undetermined origin. Gram-negative infections were associated with a response rate of 94 percent, gram-positive infections with a response rate of 75 percent, and polymicrobial infections with a response rate of 82 percent. Resistance to ciprofloxacin did not develop and no superinfections were seen. Toxicity was minor except in one patient, in whom a seizure developed. Intravenously administered ciprofloxacin is effective and safe therapy for many infections in cancer patients.

Bacterial Infections↗
PubMed1989

Spectrum and outcome of microbiologically documented listeria monocytogenes infections in cancer patients.

At the M.D. Anderson Cancer Center (Houston), Listeria monocytogenes was cultured from 14 patients between 1980 and 1987. The case records of 11 of these patients were reviewed. Underlying malignancies included acute leukemia (three), lymphoma (two), myeloma (one), adenocarcinoma of colon (two), carcinoma of breast (one), carcinoma of lung (one), and Kaposi's sarcoma associated with the acquired immune deficiency syndrome (one). Listeria monocytogenes was cultured from blood (eight patients), cerebrospinal fluid (CSF) (two patients), and from both blood and CSF in one patient. All patients were receiving immunosuppressive therapy including corticosteroids in seven. An absolute neutrophil count of less than 1000/mm3 was noted in five. Bacteremia was the predominant type of infection and ten patients responded to antimicrobial therapy.

Adult↗
PubMed1989

Emerging fungal pathogens.

Fungi such as Fusarium spp., Curvularia spp., Alternaria spp. or Trichosporon beigelii, had been thought to represent contamination or harmless colonization when isolated from humans. More recently, the role of these and other newly recognized fungi as serious pathogens has been clearly established. Three diverse groups of fungi are responsible for these infections: the agents of phaeohyphomycosis and hyalohyphomycosis and certain yeasts. These infections, which have been encountered in both presumably healthy and immuno-compromised individuals, tend to be localized in the former, and disseminated and frequently fatal in the latter group of patients. A major concern is that these organisms are not uniformly susceptible to amphotericin B. Standardization of antifungal susceptibility testing may, therefore, be helpful in determining the antifungal drug of choice for each infection. It is also hoped that the advent of newer antifungals and biologic response modifiers will have a significant impact on the morbidity and mortality of these emerging infections.

Alternaria↗
PubMed1989

Aspergillosis.

Aspergillus spores are ubiquitous in the environment and may become concentrated in hospital ventilation systems. Colonization in normal hosts can lead to allergic diseases ranging from asthma to allergic bronchopulmonary aspergillosis. Normal hosts rarely develop invasive disease, which is primarily an infection of severely immunocompromised patients. The major predisposing factors for infection include prolonged neutropenia, chronic administration of adrenal corticosteroids, the insertion of prosthetic devices, and tissue damage due to prior infection or trauma. Since Aspergillus spp. are respiratory pathogens, the most common form of infection is pneumonia followed by sinusitis. Patients with preexistant cavitary disease may develop noninvasive aspergillomas. Most infections are caused by Aspergillus fumigatus. The organism is capable of invading across all natural barriers, including cartilage and bone. It has a propensity for invading blood vessels causing thrombosis and infarction. The diagnosis of pulmonary infection is usually difficult to establish because the organism is seldom cultured from sputum and can represent contamination in some cases. Therapy is immunocompromised hosts is less than satisfactory and amphotericin B is the only agent with significant activity. There is anecdotal evidence to suggest that the addition of 5-fluorocytosine to amphotericin B may be beneficial.

Aspergillosis↗
PubMed1989

In vitro activity of trospectomycin (U-63366F), a novel spectinomycin analog, against gram-positive isolates from cancer patients.

The in vitro activity of trospectomycin was compared to that of amikacin, cephalothin and vancomycin against gram-positive organisms, mostly isolated from cancer patients. Trospectomycin was considerably more active than amikacin against most isolates tested, particularly species of Staphylococcus and Streptococcus. Overall, vancomycin was the most active agent tested.

Amikacin↗
PubMed1989

Intertriginous infections in adults receiving antileukemia chemotherapy.

Because intertriginous infections in patients receiving antileukemia chemotherapy may be life-threatening, all sites where skin contacts skin should be thoroughly examined daily. Early detection and immediate medical intervention designed to confine and cure the infection before it progresses to blood-borne dissemination of the infecting organisms are essential in these immunosuppressed patients.

Antineoplastic Agents↗
PubMed1989

In-vitro activity of PD 117558, a new quinolone against bacterial isolates from cancer patients.

The in-vitro activity of PD 117558, a new quinolone antimicrobial agent, was compared to that of four other quinolones, imipenem and ceftazidime against a variety of Gram-positive and Gram-negative isolates from cancer patients. PD 117558 was found to have a broad antimicrobial spectrum with excellent activity against all Gram-positive isolates (including methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus faecalis and Group JK-corynebacteria). It was also extremely active against Gram-negative bacilli with the exception of Pseudomonas aeruginosa against which ciprofloxacin was more active. Fleroxacin was slightly less active and S-25930 and S-25932 considerably less active than PD 117558. PD 117558 also had lower minimal inhibitory concentrations for most organisms tested than either imipenem or ceftazidime.

4-Quinolones↗
PubMed1989

Comparative in-vitro activity of twenty antimicrobial agents against clinical isolates of Mycobacterium avium complex.

The in-vitro susceptibility of Mycobacterium avium complex isolates, obtained from immunosuppressed patients with and without the Acquired Immunodeficiency Syndrome (AIDS), to various antimicrobial agents was determined. Amikacin, the 4-quinolone compounds--ciprofloxacin, temafloxacin and PD 117558--and the penem SCH 34343 were active against most of the isolates. In-vitro synergism using selected antimicrobial combinations could not be demonstrated. No differences in the susceptibility, depending upon the source of the isolates (AIDS or non-AIDS), were noted.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Oral ciprofloxacin therapy for infections in cancer patients.

Forty six episodes of infection in 43 cancer patients were treated with oral ciprofloxacin at a dose of 750 mg every 8 h. The overall clinical response was 85%. Patients with microbiologically proven infections had a higher response rate (90%) than patients with infections from whom no causative organism(s) could be isolated (69%). Two of three neutropenic patients responded favourably. Favourable responses were seen in a variety of infections including bacteraemia, urinary tract infection, respiratory tract infection and skin and soft-tissue infection. Resistance to ciprofloxacin developed in one isolate of Pseudomonas aeruginosa. Side effects were mild and were predominantly gastrointestinal in nature. Orally administered ciprofloxacin is safe and effective for the therapy of many serious infections in cancer patients. However, more data are required in patients who are neutropenic.

Adult↗
PubMed1989

Bacteremia caused by non-sporulating anaerobes in cancer patients. A 12-year experience.

The clinical, epidemiological and laboratory characteristics of bacteremia caused by anaerobic organisms other than Clostridium spp. in cancer patients are described and compared to other previously reported series. Of the 315 episodes, 246 (78%) were caused by a single organism and 69 (22%) were polymicrobial. The most common underlying malignancies were genitourinary and gynecological tumors, acute leukemia, and gastrointestinal malignancies. Most patients (94%) were febrile, and septic shock was documented in 24% of monomicrobial episodes and in 58% of those with polymicrobial infection. Soft-tissue infection was present in 44% of the cases, and it presented as tissue necrosis in 11%. The most common sites identified as the portal of entry were intra-abdominal abscesses, soft tissue, and the oropharynx. The most common organisms were Bacteroides fragilis (57%) and other Bacteroides spp. (22%). Most polymicrobial infections were caused by 2 organisms, the second most commonly another anaerobe or an aerobic gram-negative bacillus. The most active antibiotic in vitro was chloramphenicol. High rates of resistance to penicillin were observed not only among B. fragilis, but also among Bacteroides spp. The frequency of penicillin resistance increased throughout the study years. The overall survival was 70%. The cure rate for monomicrobial bacteremias was 76% vs. 51% for polymicrobial episodes. Infection was the cause of death in 20 and 16 episodes, respectively. The response rate for patients in septic shock was 47% in contrast to an 85% recovery rate for those without it. Ninety-five patients had documented abscesses accompanying the bacteremic episode. The most effective antibiotics were clindamycin and chloramphenicol. Overall response to penicillin was only 13%. Suboptimal responses were also observed for the antipseudomonal penicillins. High response rates (82%) were also obtained with cefoxitin, metronidazole, and moxalactam.

Adolescent↗