Table 54-4.
Prevention of Infectious Complications in Compromised Patients
| Ways to Prevent Acquisition of, Suppress, or Eliminate Microbial Flora | Examples |
|---|---|
| Isolation | |
| Total protective isolation with high-efficiency particulate air filters and absorbable or nonabsorbable antibiotics for bone marrow–transplant recipient | |
| Prophylactic Antibacterial Drugs | |
| Norfloxacin | Reduce bacterial infections in neutropenic patients |
| Trimethoprim-sulfamethoxazole | Suppress flora in chronic bronchitis patients |
| Penicillin | Reduce frequency of streptococcal infections after splenectomy or rheumatic valvular disease or graft-versus-host disease |
| Rifabutin | Prevention of Mycobacterium avium complex in patients with advanced HIV disease |
| Isoniazid | Prevention of tuberculosis in PPD-positive individuals |
| Nonabsorbable broad-spectrum agents (i.e., aminoglycoside, plus bacitracin) | Gut decontamination for neutropenic patients |
| Prophylactic Antiviral Drugs | |
| Oral acyclovir or valganciclovir, or IV ganciclovir | Reduce frequency of CMV disease following transplantation |
| Rimantadine, oseltamivir | Prevent influenza |
| Prophylactic Antifungal Drugs | |
| Fluconazole | Prevent recurrent candidiasis |
| Liposomal amphotericin B or voriconazole or caspofungin | Prevent Candida or mold infections |
| Trimethoprim-sulfamethoxazole | Prevent Pneumocystis pneumonia |
| Prophylactic Antiprotozoal/Anthelmintic Drugs | |
| Albendazole or ivermectin | Prevent disseminated strongyloidiasis in high-risk patients |
| Augment Host Defenses | |
| Immunization | Pneumococcal and Haemophilus vaccine for patients before splenectomy |
| Immune serum globulin | Augment levels in deficient patients (e.g., common variable immunodeficiency) |
| Fresh frozen plasma | Augment complement levels in deficient patients |
| Neutrophil transfusions | Augment inflammatory response in neutropenic patients or patients with chronic functional neutrophil disorders |
| Lymphocyte or other mononuclear cell transfusions | Experimental therapies for tumors, various immunodeficiencies |
| Bone marrow or stem cell transplant | Reconstitute patients with congenital immunodeficiencies or certain acquired cytopenias |
| Bone marrow human stem cell stimulation | G-CSF or GM-CSF to increase neutrophil or mononuclear cell quantity and function |
| Gene therapy | Replace genes to allow normal function |
AIDS, acquired immunodeficiency syndrome; CMV, cytomegalovirus; G-CSF, granulocyte colony-stimulating factor; GM-CSF, granulocyte-monocyte colony-stimulating factor; HIV, human immunodeficiency virus; PPD, purified protein derivative.