The efficacy of prophylactic outpatient antibiotics for the prevention of neutropenic fever associated with high-dose etoposide (VP-16) for stem cell mobilization.

High-dose etoposide (2 g/m(2)) plus G-CSF is a very effective regimen for peripheral blood progenitor cell (PBPC) mobilization. Unfortunately, neutropenia is common. The infectious complications associated with high-dose etoposide have not been previously described. After noting a high incidence of hospitalizations for neutropenic fever, we began a vigorous prophylactic antibiotic regimen for patients receiving high-dose etoposide plus G-CSF, attempting to reduce infectious complications. Ninety-eight patients underwent etoposide mobilization between December 1997 and June 2000. Three chronological patient groups received: (1) no specific antibiotic prophylaxis (n = 44); (2) vancomycin i.v., cefepime i.v., clarithromycin p.o., and ciprofloxacin p.o. (n = 27); and (3) vancomycin i.v., clarithromycin p.o., and ciprofloxacin p.o. (n = 27). The patients not receiving antibiotic prophylaxis had a 68% incidence of hospitalization for neutropenic fever. In the patients receiving prophylaxis, the incidence was reduced to 26% and 15% respectively, for an overall incidence of 20% (P < 0.001 for comparison between prophylaxed and unprophylaxed groups). We conclude that etoposide mobilization is associated with a significant incidence of neutropenic fever, which can be substantially reduced by a vigorous antimicrobial prophylactic program.

[The fetus between abortion and protection of life]. / Die Leibesfrucht zwischen Abtreibungs- und Lebensschutz.

PIP: Despite the distinctions made in the Abortion Act Paragraph 218 et seq. StGB overlaps and gaps occur with the transition from the protection of "unborn life" to the protection of "born life" which leads to restrictions in the law concerning legal protection of life. These problems occur particularly with organ transplants from and medical experiments on living fetuses following legal abortion. In order to afford an optimal protection of life, a clear definition is necessary. Here, however, the reduced penalty, compared with born life, according to Paragraph 218 et seq. StGB must also be considered. The following points are valid. 1) When medically indicated, the chance of an early birth as an alternative to abortion should be carefully considered. 2) The extension of the legal protection of life into the birth process cannot be transferred to the process of abortion because of the structure of the law; i.e., in abortion, the legal protection of life and integrity come into force only after delivery of the fetus. 3) Following delivery of the fetus, Paragraphs 211 et seq. and 223 et seq. StGB come into force whether or not there is a chance of life; i.e., organ transplants from and medical experiments on living fetuses after legal abortion are, in principle, forbidden. 4) With legal abortion, the doctor is not obliged, except when medically indicated, to resuscitate a living fetus. The time limits for an abortion according to Paragraph 218 exclude any chance of life so that, following the principles of passive euthanasia, there is no special responsibility or general duty to save that life. (author's)^ieng