NCCN肿瘤相关感染的预防与治疗指南2017.2版（7）
抗病毒药物表(FEV-C)
FEV-C,4-1/4-2/4-3
抗病毒药物a
a.肾功能不全患者需调整剂量。
b.给药剂量是成人剂量。儿童患者的剂量参阅儿科指南。
c.抗病毒预防应针对特定的高危患者（见inf-3）。在非移植、高危患者，预防应用于HSV或VZV血清学阳性的患者（或有水痘病史）。HCT受者，如果供体或受体是病毒阳性，需要预防治疗。抗病毒药物的指导剂量适用于肾功能正常的成人；在儿科患者和肾功能损害患者，剂量查阅说明书。预防性抗病毒剂量可能高于免疫正常人群的常规用药剂量（如复发性冷疮）。在血液系统恶性肿瘤患者和HCT患者的不同临床试验中，阿昔洛韦的预防剂量有很大的变化。
d.大剂量阿昔洛韦和伐昔洛韦已用于预防CMV。因为这些药物对巨细胞病毒的抗病毒活性较弱，CMV病高风险患者需要监测CMV和用更昔洛韦、缬更昔洛韦或膦甲酸钠抢先治疗。
e.一般，异基因HCT患者，PCR法监测CMV，继之对阳性者抢先抗CMV治疗，优于长期预防。
f.不太严重的腺病毒感染通常给予1毫克/公斤，每周三次。
g.不能口服奥塞米韦的患者考虑或扎那米韦吸入或帕拉米韦吸入。
h.社区和医院甲型流感爆发时，严重免疫力低下人群应考虑预防。
i.吸入利巴韦林仅被FDA批准用于住院的严重下呼吸道呼吸道合胞病毒感染的婴幼儿。
FEV-C,4-4
抗病毒药物-参考文献
1.Boeckh M, Kim HW, Flowers MED, Meyers JD, and Bowden RA. Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation -- a randomized double-blind placebo-controlled study. Blood 2006;107:1800-1805.
2.Zaia JA. Prevention and management of CMV-related problems after hematopoietic stem cell transplantation. Bone Marrow Transplant 2002;29:633-638.
3.Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy (37th ed.). Hyde Park, VT: Jeb E. Sanford Publishers.2007.
4.Ljungman P, de La Camara R, Milpied N, et al. Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants. Blood 2002;99:3050-3056.
5.Frechette G, Romanowski B. Efficacy and safety of famciclovir for the treatment of HSV infection in HIV+ patients. Can J Infect Dis 1997;8(Suppl A):44A.
6.Schacker T, Hu H, Koelle DM, et al. Famciclovir for the suppression of symptomatic and asymptomatic herpes simplex virus reactivation in HIV-infected persons: A double-blind, placebo-controlled trial. Ann Intern Med 1998;128:21-28.
7.Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15:1143-1238.
8.Reusser P, Einsele H, Lee J, et al. Randomized multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002;99:1159-1164.
9.Vu D, Peck AJ, Nichols WG, et al. Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective case-control study. Clin Infect Dis 2007;45:187-193.
10.Heegaard Ed, Brown KE. Human parvovirus B19. Clin Microbial Rev 2002;15:485-505.
11.Whimbey E, Champlin RE, Englund JA, et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. Bone Marrow Transplant 1995;16:393-399.
12.Marcelin JR, Wilson JW, Razonable RR.Oral ribavirin therapy for respiratory syncytial virus infections in moderately to severely immunocompromised patients. Transpl Infect Dis 2014;16: 242-250.
风险评估资源(FEV-D)
1.MASCC危险指数只适用于成年人，不适用于儿童患者。
2.Klastersky J, Paesmans M, Rubenstein EJ et al. The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000;18:3038-51.
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