What is the role of antibiotic therapy in pediatric acute myelocytic leukemia (AML) treatment?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Infection is a major cause of morbidity and mortality in acute myeloid leukemia.

Patients with fever, particularly if they have severe neutropenia, are presumed to have serious infection until proven otherwise.

Empiric, broad-spectrum antibacterial antibiotics are administered when a patient is febrile and has an absolute neutrophil count of less than 7.5-10 X 109/L (< 750-1000/μL) (see the Absolute Neutrophil Count calculator). The choice of antibiotics depends on the typical pathogens found in the community and hospital. It is usually some combination of an aminoglycoside and a cephalosporin or semisynthetic penicillin with beta-lactamase inhibitor, until culture results are available.

When tunnel infections around a central venous catheter are suspected, vancomycin should be administered. At certain institutions, removal of the intravenous line is also recommended.

If a patient presents with abdominal or GI symptoms, the antibiotic chosen should cover anaerobes.

When neutropenia is prolonged, particularly after treatment with broad-spectrum antibacterial agents, fungal disease becomes a great concern.

Empiric use of antifungal therapy is indicated in patients with persistent fever 3-5 days after initiation of broad-spectrum antibiotics and negative bacterial cultures. Although amphotericin has been the standard treatment for many years, other agents, such as voriconazole, caspofungin and micafungin are increasingly used.

(To facilitate proper diagnosis of infection, bronchoscopy, lung biopsy, and imaging studies are often necessary. CT scanning is often required to detect subtle abscesses in the lungs, liver, spleen, kidneys, or brain.)

Vigilance is most important in the patient with acute myeloid leukemia and persistent fever. Frequent cultures of possible sites of infection should be performed.


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