Schrøder H, Agger K E, Rosthøj S, Carlsen N T, Schmiegelow K
Department of Pediatrics, University Hospital of Aarhus.
Dan Med Bull. 2001 Nov;48(4):275-7.
Children with acute lymphoblastic leukemia are treated with intensive chemotherapy resulting in profound immuno suppression. Therefore treatment with trimethoprim-sulfamethoxazole (TMP-SMX) may be used for prophylaxis against infections both with bacteria and Pneumocystis carinii in some departments. The use of TMP-SMX for prophylaxis during the induction therapy is not uniform in the four departments of pediatric oncology in Denmark. This gave us the opportunity to describe the effect of TMP/SMX on bacterial infections in children with ALL during the induction therapy.
Between January 1st 1992 and December 31st 1997, 210 children were diagnosed with ALL in Denmark. Based on a retrospective review of the medical charts the number of children with fever (>38 degrees C), the number of febrile days, days of antibiotic treatment and the number of positive blood cultures were registered for every febrile episode.
One hundred and fourteen children received TMP/SMX prophylaxis (10-30 mg/SMX/kg/day) and 76 did not. Children who received TMP/SMX prophylaxis had significantly fewer episodes of fever (66/114 (58%) v 60/76 (79%), p <0,01), and significantly fewer children who received TMP/SMX prophylaxis had positive blood cultures before start of antibiotic treatment compared with children who did not receive prophylaxis (23/114 (20%) vs 37/76 (49%), p<0.001)). Nineteen different species were isolated from the blood stream before start of antibiotic treatment. In the non-prophylaxis group there was a preponderance of isolates with Staph. aureus, Str. pneumoniae, E. coli and P. aeruginosa. There was no difference in the mortality between the two groups (p=0.44). There were no cases of P carinii pneumonia in the period of induction therapy.
TMP/SMX prophylaxis during induction therapy for childhood ALL seems to reduce the risk of bacteremias and febrile illness.
急性淋巴细胞白血病患儿需接受强化化疗，这会导致严重的免疫抑制。因此，在一些科室，可使用甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）预防细菌和卡氏肺孢子虫感染。在丹麦的四个儿科肿瘤科室中，诱导治疗期间TMP - SMX预防用药情况并不一致。这使我们有机会描述TMP/SMX对急性淋巴细胞白血病患儿诱导治疗期间细菌感染的影响。
1992年1月1日至1997年12月31日期间，丹麦有210名儿童被诊断为急性淋巴细胞白血病。通过回顾病历，记录每次发热发作时体温超过38摄氏度的儿童数量、发热天数、抗生素治疗天数以及血培养阳性数量。
114名儿童接受了TMP/SMX预防治疗（10 - 30mg/SMX/千克/天），76名儿童未接受。接受TMP/SMX预防治疗的儿童发热发作次数显著减少（66/114（58%）对60/76（79%），p <0.01），与未接受预防治疗的儿童相比，接受TMP/SMX预防治疗的儿童在开始抗生素治疗前血培养阳性的人数显著减少（23/114（20%）对37/76（49%），p<0.001）。在开始抗生素治疗前，从血流中分离出19种不同菌种。在未预防治疗组中，分离出的菌株以金黄色葡萄球菌、肺炎链球菌、大肠杆菌和铜绿假单胞菌为主。两组之间死亡率无差异（p = 0.44）。诱导治疗期间无卡氏肺孢子虫肺炎病例。
儿童急性淋巴细胞白血病诱导治疗期间使用TMP/SMX预防似乎可降低菌血症和发热性疾病的风险。
