Howard Alex, Hope William
Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool, L69 3BX, UK.
JAC Antimicrob Resist. 2022 Jul 22;4(4):dlac081. doi: 10.1093/jacamr/dlac081. eCollection 2022 Aug.
Primary antifungal chemoprophylaxis (PAC) is the widespread strategy of choice for the prevention of invasive fungal disease in patients with acute leukaemia (AL). Twice-weekly monitoring of the serum biomarkers (SBM) galactomannan and 1,3-β-d-glucan has been proposed as an alternative prevention strategy to PAC for these patients. This paper outlines the arguments for why PAC should remain as the standard of care in AL, instead of switching to twice-weekly SBM. Arguments put forward in favour of PAC are the strength of evidence for its safety, cost-effectiveness and adaptability, and its adoption by multiple international guidelines as standard of care. The potential implications of PAC for drug interactions and antifungal resistance are also discussed. The drawbacks of twice-weekly SBM are appraised, including missed or delayed diagnoses, unnecessary investigations, deferral of systemic anti-cancer therapy and increased pressure on laboratory services.
原发性抗真菌化学预防（PAC）是预防急性白血病（AL）患者侵袭性真菌病的广泛选择策略。有人提出，对这些患者每两周监测一次血清生物标志物（SBM）半乳甘露聚糖和1,3-β-D-葡聚糖，作为PAC的替代预防策略。本文概述了为何PAC应继续作为AL的护理标准，而不是改为每两周进行一次SBM监测的理由。支持PAC的理由包括其安全性、成本效益和适应性方面的有力证据，以及被多个国际指南采用为护理标准。还讨论了PAC对药物相互作用和抗真菌耐药性的潜在影响。评估了每两周进行一次SBM监测的缺点，包括漏诊或延迟诊断、不必要的检查、全身抗癌治疗的推迟以及实验室服务压力增加。
