Perils of Prophylaxis

A major threat to patients with granulocytopenia and cancer is infection. Most infections develop from either endogenous or hospital-acquired organisms colonizing the alimentary tract and upper airways. Total reverse isolation with laminar air-flow rooms and microbial suppression with oral nonabsorbable antibiotics are effective in reducing infection, but their application is limited by expense and patient compliance.1 Hence, reports that oral prophylaxis with trimethoprim–sulfamethoxazole (TMP-SMX) without isolation precautions was also protective in patients with granulocytopenia have led to widespread adoption of this regimen.In this issue, Wilson and Guiney report on two patients with acute leukemia and granulocytopenia who were receiving . . .