Henry S A
Am J Med. 1984 Apr;76(4):645-51. doi: 10.1016/0002-9343(84)90289-4.
Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.
多项前瞻性随机试验表明，预防性口服不吸收抗生素可能有助于降低粒细胞减少患者的感染发生率，但其他试验则未得出此结论。在一些研究中，难以忍受的恶心和呕吐阻碍了这些药物的长期使用。在患者仍处于粒细胞减少状态时停止治疗，会带来危及生命的感染风险，且往往是由对氨基糖苷类耐药的革兰氏阴性菌引起。预防性使用甲氧苄啶/磺胺甲恶唑进行选择性肠道去污的益处仍存在争议。使用甲氧苄啶/磺胺甲恶唑也可能与耐药的潜在致病微生物的出现或长期中性粒细胞减少有关。当预计患者中性粒细胞减少持续时间少于三周时，这些治疗方案似乎并不适用。即使对于长期中性粒细胞减少的患者，也必须权衡这种治疗的风险与潜在益处。
