Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Department of Pharmacy, University of Washington Medicine, Seattle, Washington, USA.
Transpl Infect Dis. 2023 Nov;25 Suppl 1:e14129. doi: 10.1111/tid.14129. Epub 2023 Aug 18.
Appropriate use of antimicrobials for hematologic malignancy, hematopoietic stem cell transplant recipients, and other cellular therapies is vital, with infection causing significant morbidity and mortality in this unique population of immunocompromised hosts. However, often in this population the choice and management of antimicrobial therapy is complex. When selecting an antimicrobial agent, key considerations include the need for dose adjustments due to renal or hepatic impairment, managing drug interactions, the potential for additive drug toxicity among those receiving polypharmacy and therapeutic drug monitoring. Other factors include leveraging pharmacodynamic principles to enable optimization of directed therapy against challenging pathogens, as well as judicious use of antimicrobials to limit drug resistance and adverse drug reactions.
This review summarizes the clinical considerations for commonly used antimicrobials in this setting, including antibacterial, antiviral, and antifungal agents.
血液恶性肿瘤、造血干细胞移植受者和其他细胞治疗患者对抗菌药物的合理应用至关重要，因为感染会给这群免疫功能低下的宿主带来严重的发病率和死亡率。然而，在这群人群中，抗菌药物治疗的选择和管理往往非常复杂。在选择抗菌药物时，需要考虑的关键因素包括由于肾功能或肝功能受损而需要调整剂量、管理药物相互作用、接受多种药物治疗的患者之间可能出现药物毒性的叠加以及治疗药物监测。其他因素包括利用药效学原理优化针对挑战性病原体的靶向治疗，以及合理使用抗菌药物以限制耐药性和药物不良反应。
本文综述了该治疗环境中常用抗菌药物的临床注意事项，包括抗菌药物、抗病毒药物和抗真菌药物。
