How to Treat Myelodysplastic Syndromes?
- July 26, 2023
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Medical Treatment:
- Transfusion should ideally be with leucodepleted red cells to delay immunisation, as these patients require frequent transfusions.
- Bone marrow transplantation can be curative in selected patients.
- 3rd generation cephalosporin, e.g:
- Ceftriaxone, IV, 1 g daily.
- Gentamicin, IV, 6 mg/kg daily.
ADD:
- Vancomycin, IV, 20 mg/kg/dose 12 hourly.
- Monitor trough levels after the third dose.
- Adjust dose to maintain a trough level of 15-20 micromol/L.
Choice will depend on local susceptibility patterns. One or more of the following antibiotics/classes must be available:
- Piperacillin/tazobactam, IV, 4.5 g 8 hourly or cefepime, IV, 1 g 12 hourly.
Carbapenem with activity against Pseudomonas, e.g:
- Meropenem, IV, 1 g 8 hourly or Imipenem, IV, 500 mg 6 hourly.
Ertapenem is not recommended because it is not effective for pseudomonas species which are important pathogens in this setting.
If no response after 5-7 days:
ADD
- Amphotericin B, IV, 1 mg/kg daily in dextrose 5 % over 4 hours.
- Ensure adequate hydration to minimise nephrotoxicity.
- Regular, e.g. 3 times a week, monitoring of potassium, magnesium and renal function is essential.
- If neutrophil count increases to greater than 0.5 x 109/L, continue for 2 days after fever has settled.
- If neutrophil count remains equal to or less than 0.5 x 109/L, continue for 7 days after fever has settled.
- All patients for further investigation and management.
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