Neutropenic sepsis rates in patients receiving bleomycin, etoposide and cisplatin chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen
Objective: Once daily dosing (ODD) aminoglycoside is gaining wide acceptance as an alternative way of dosing. In our setting it is the regimen of choice whenever gentamicin is indicated. The objective of this study was to evaluate the practice of gentamicin ODD in a public hospital in Malaysia. Methods: We conducted a retrospective review of medical records of patients on gentamicin ODD who were admitted to Hospital Melaka during January 2002 until March 2010. All adult patients who were on ODD gentamicin with various level of renal function were included in the study. Patients on gentamicin less than 72 hours and pregnant women were excluded. Results: From 110 patients, 75 (68.2%) were male and 35 (31.8%) were female. Indications for ODD gentamicin included pneumonia, 34 (31.0%) neutropenic sepsis, 27 (24.5%) and sepsis, 11 (10.0%). The mean dose and duration of gentamicin was 3.2 mg/kg/day and 7 days, respectively. Almost all patients were on gentamicin combined with other antibiotics. Clinical cure based on fever resolution was found in 89.1% of patients treated with ODD. Resolution of fever took an average of 48 hours after initiation of therapy. The evaluation for bacteriologic cure could not be performed because of insufficient data on culture and sensitivity. Out of 38 patients with analyzable serum creatinine data, four patients might have developed nephrotoxicity. Conclusion: In our setting, lower dosages of ODD gentamicin when used in combination with other antibiotics seemed to be effective and safe in treating most gram negative infections.
Background Langerhans cell histiocytosis (LCH) involves abnormal
proliferation of Langerhans cells (LC), which is typically driven by the
BRAF V600E mutation. High-risk LCH has a poor prognosis. Procedure
Fifteen children (5 girls, 10 boys) with BRAF V600E+ LCH received
vemurafenib (initial dose median 40 mg/kg/day, range: 11–51.6
mg/kg/day) between March 2016 and February 2020. All patients had
previous received LCH-directed chemotherapy. The median age at LCH onset
was 2 months (range: 1–28 months) and the median age at the start of
vemurafenib treatment was 22 months (range: 13–62 months). The median
disease activity score (DAS) at the start of vemurafenib treatment was
12 points (range: 2–22 points). Results The median duration of
vemurafenib therapy was 29 months (range: 2.4–45 months). All patients
responded to treatment, with median DAS values of 4 points (range: 0–14
points) at week 4 and 1 point (range: 0–3 points) at week 26.
Toxicities included skin/hair changes (93%) and non-significant QT
prolongation (73%). Two patients died, including 1 patient who
experienced hepatic failure after NSAID overdose and 1 patient who
developed neutropenic sepsis. Electively stopping vemurafenib treatment
resulted in relapse in 5 patients, and complete cessation was only
possible for 1 patient. Digital droplet PCR for BRAF V600E using
cell-free circulating DNA revealed that 7 patients had mutation statuses
that fluctuated over time. Conclusion Our study confirms that
vemurafenib treatment is safe and effective for young children with BRAF
V600E+ multisystem LCH. However, treatment using vemurafenib does not
completely eliminate the disease.
Prevention and management of neutropenic sepsis in patients with cancer: summary of NICE guidance