RESPIRATORY-FAILURE ELICITED BY STREPTOCOCCAL SEPTICEMIA IN PATIENTS TREATED WITH CYTOSINE-ARABINOSIDE, AND ITS PREVENTION BY PENICILLIN

In order to prevent septicaemia with streptococci, 20 consecutive selectively decontaminated patients on intermediate high-dose Ara-C treatment for malignant haematological disease were given pencillin G. The incidence of infection with streptococci decreased from 0.76 per episode (14 patients, 17 episodes) for controls who did not receive penicillin G to 0.11 per episode in the prophylaxis group (20 patients, 26 episodes). Simultaneously, a decrease in the incidence of respiratory failure was observed, i. e. 0.52 per episode for controls and 0.19 per episode for patients on penicillin G. The results suggest that septicaemia with streptococci triggers the development of noncardiogenic pulmonary oedema in patients with pre-existing damage of the lung due to aggressive cytotoxic treatment. This suggestion is supported by the sequence of events, regarding the occurrence of infection and respiratory failure and the results of measurements of antileukoprotease serum concentrations, a paramenter for pulmonary capillary leakage. Taking into account the data in the literature and the results of the present study, the conclusion is drawn that in patients treated with (intermediate) high dose Ara-C, prevention of streptococcal septicaemia is associated with a decrease in the incidence of respiratory failure. © 1990 MMV Medizin Verlag GmbH München.