Symposium on Infectious Complications of Neoplastic Disease (Part II). Current Status of Prophylaxis of Infection with Protected Environments

Protected environments and prophylactic antibiotics have been evaluated as a method for reducing the risk of infection in patients undergoing cancer chemotherapy. Initial studies were conducted in patients with acute leukemia, and most of them demonstrated that patients in the protected environment/prophylactic antibiotic program had fewer infections and infectious deaths than control patients. In two studies, remission rates were significantly higher for the group in the protected environment/prophylactic antibiotic program. Subsequently, studies were conducted in patients with lymphoma, sarcoma, and breast carcinoma. The protected environment/prophylactic antibiotic program reduced the risk of infection and permitted the administration of higher doses of chemotherapy. However, the more intensive chemotherapy only minimally improved response rates or durations of response. Further studies should be directed toward identifying those patients most likely to benefit from this prophylactic program.