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Antifungal Therapy in High-Risk Patients
Release date: January 2008
Expiration date: January 31, 2009
Estimated time to complete activity: 3.75 hours
Hardware/Software Requirements
- Javascript-enabled browser
- Active Internet connection
- Adobe Acrobat Reader Plugin
- Adobe Flash Player Plugin v.8.0+
Sponsored by
Support for this activity has been provided through an educational grant from
Activity Overview
Invasive fungal infections are of particular concern in immunocompromised and immunosuppressed patients, such as those with hematologic malignancies and those undergoing chemotherapy, in whom they are a leading cause of infection-related mortality. Complicating the provision of care to this patient population are such factors as the emergence of resistance to routine antifungal agents, changes in the landscape of pathogens, and the presence and effect of comorbidities. This activity is designed to provide clinicians and other health care professionals the up-to-date knowledge they require to most effectively manage invasive fungal infections in their hematology-oncology patients.
This activity is divided into 3 sections:
- Antifungal Agents in the Treatment of Opportunistic Infections in Hematology-Oncology Patients highlights information presented at a satellite symposium held in conjunction with the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy Congress.
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The Changing Landscape of Invasive Fungal Infections features highlights from a satellite symposium presented at the Infectious Diseases Society of America 45th Annual Meeting.
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Hot Topics in Opportunistic Fungal Infections and Antifungal Agents contains highlights from two infectious disease congresses held September 17–20 and October 4–7, 2007 and clinically focused interviews with two infectious disease experts.
You may claim credit for each section individually or you may choose to complete all three sections for full credit. See Method of Participation for additional information.
Target Audience
This activity has been designed to meet the educational needs of infectious disease specialists, clinicians, researchers, and other health care professionals who care for hematology-oncology patients.
Learning Objectives
Upon completion of this activity, participants should be better able to:
- Recognize the prevalence of opportunistic invasive fungal infections in high-risk hematology-oncology patients
- Describe the trends of emerging resistance to current antifungal agents
- Evaluate the data to support the best strategies for managing invasive fungal infections in immunocompromised and immunosuppressed patients, including the role of prophylaxis and preemptive and empiric treatment
- Assess the association of invasive fungal infections with the use of immunomodulating agents
- Examine the role of diagnostics in the management of invasive fungal infections
Activity Chairs/Moderators
Kieren A. Marr, MD View biography
Professor of Medicine, Division of Infectious Diseases
Director, Transplant Infectious Disease Program
Director, Infectious Diseases Clinical Research Center
Oregon Health and Science University
Portland, Oregon
John R. Perfect, MD View biography
Professor of Medicine
Associate Professor of Molecular Genetics and Microbiology
Duke University Medical Center
Durham, North Carolina
ACTIVITY FACULTY
Pranatharthi H. Chandrasekar, MD View biography
Professor, Department of Medicine
Wayne State University School of Medicine
Karmanos Cancer Institute
Detroit, Michigan
Amelia A. Langston, MD View biography
Associate Professor of Hematology-Oncology
Medical Director, BMT Program
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia
John R. Wingard, MD View biography
Professor of Medicine
Department of Medicine
Professor, Department of Pediatrics
Director, Blood and Bone Marrow Transplant Program
University of Florida Shands Cancer Center
Gainesville, Florida
Accreditation Statement
Curatio CME Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation
Curatio CME Institute designates this educational activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Physicians should not claim credit for this activity if credit was previously claimed for the symposium on which this Internet activity is based.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period January 2008 to January 31, 2009, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.
This CME activity is divided into three sections. If you choose to complete individual sections, please complete the corresponding posttest questions and evaluation, then check the appropriate box(es) on the certificate information portion of the evaluation form to indicate the section(s) for which you wish to obtain credit.
To obtain a certificate, you must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com
Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.
Disclosure
In accordance with the ACCME’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:
Kieren A. Marr has disclosed the following relevant financial relationships:
| Consultant: |
Astellas, Basilca, Cubist, Enzon, Merck, Nektar, Pfizer, Schering-Plough |
Dr. Marr discusses the unlabeled or investgational use of a commerical product.
John R. Perfect, MD has disclosed the following relevant financial relationships:
| Advisor/Consultant: |
Astellas, Enzon, Merck, Pfizer, Schering-Plough |
| Investigator : |
Astellas, Enzon, Merck, Pfizer, Schering-Plough |
Pranatharthi H. Chandrasekar, MD has disclosed the following relevant financial relationships:
| Consultant: |
Enzon |
| Speaker: |
Merck, Schering-Plough |
| Research Support: |
Pfizer, Schering-Plough |
Daniel R. Couriel, MD has disclosed no relevant financial relationships.
Amelia A. Langston, MD has disclosed the following relevant financial relationships:
| Advisor/Consultant: |
Schering-Plough |
| Investigator: |
Schering-Plough |
John R. Wingard, MD has disclosed the following relevant financial relationships:
| Consultant: |
Merck, Pfizer |
| Speakers Bureau: |
Merck, MGI Pharma, Pfizer, Schering-Plough |
| Grants: |
Merck, Pfizer |
Curatio CME Institute
Shari J. Dermer, PhD, Medical Director, has disclosed no relevant financial relationships.
Thomas Finnegan, PhD, Medical Writer, has disclosed no relevant financial relationships.
Danielle Hesser, Program Manager, has disclosed no relevant financial relationships.
Barbara Landers, Vice President, Medical Education Programs, has disclosed no relevant financial relationships.
Brett Mutschler, CME Director, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Disclaimer
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.
Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute and Schering-Plough do not recommend the use of any agent outside the labeled indications.
The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute or Schering-Plough. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Generic Name |
Trade
Name |
Approved Use
(if any) |
Unapproved/
Investigational Use |
| Acyclovir |
Zovirax |
Acute treatment of herpes zoster
Treatment of initial episodes and the management of recurrent episodes of genital herpes
Treatment of chickenpox |
Prophylaxis of herpes viral infection in immunocompromised individuals |
| Busulfan |
Myleran® |
Palliative treatment of chronic myelogenous (myeloid, myelocytic, granulocytic) leukemia |
Conditioning for myeloablative and nonmyeloablative stem cell transplant (SCT) |
| Fluconazole |
Diflucan® |
Treatment of vaginal candidiasis (vaginal yeast infections due to Candida),
oropharyngeal and esophageal candidiasis, cryptococcal meningitis
Prophylaxis (Diflucan is also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplant who receive cytotoxic chemotherapy and/or radiation therapy) |
Prohylaxis of Aspergillus infections in patients with neutropenia and
in leukemia patients undergoing hematopoietic stem cell transplant (HSCT) who receive cytotoxic chemotherapy or radiation therapy |
| Fludarabine |
Fludara® |
Treatment of adult patients with B-cell chronic lymphocytic leukemia who have not responded to treatment, or whose disease has progressed during treatment, with at least one standard alkylating-agent containing regimen |
Conditioning for nonmyeloablative SCT |
| Infliximab |
Remicade® |
Treatment of rheumatoid arthritis, Crohn’s disease, ankylosing spondylitits, psoriatic arthritis, plaque psoriasis, ulcerative colitis |
Treatment of graft-versus-host disease (GVHD) |
| Itraconazole |
Sporonox® |
Treatment of the following fungal infections in immunocompromised and nonimmunocompromised patients: blastomycosis, pulmonary and extrapulmonary; histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis; aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy |
Prohylaxis of Aspergillus infections in HSCT recipients |
| Methotrexate |
Rheumatrex®
Trexall™ |
Treatment of the following cancers: gestational choriocarcinoma, chorioadenoma destruens, and hydatidiform mole, acute lymphocytic leukemia, meningeal leukemia, breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides, lung cancer, advanced non-Hodgkin's lymphomas, and osteosarcoma |
Prophylaxis of GVHD |
| Micafungin |
Mycamine® |
Treatment of patients with esophageal candidiasis
Prophylaxis of Candida infections in patients undergoing HSCT |
Prohylaxis of Aspergillus infections in HSCT recipients |
| Posaconazole |
Noxafil® |
Prophylaxis of invasive Aspergillus and Candida infections in patients 13 years of age and older who are at high risk of developing these infections due to being severely immunocompromised,
such as HSCT recipients with GVHD or those with hematologic malignancies with prolonged neutropenia from chemotherapy
Treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole |
Treatment of invasive Aspergillus infections, treatment of Zygomycetes infections |
| Valacyclovir |
Valtrex® |
Treatment of herpes zoster
Treatment or suppression of genital herpes in immunocompetent individuals and for the suppression of recurrent genital herpes in HIV-infected individuals |
Prophylaxis of herpes viral infection in immunocompromised individuals |
| Vancomycin |
Lyphocin®
Vancocin®
Vancoled® |
Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant staphylococci
Indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs |
Empiric treatment of fever |
| Voriconazole |
VFEND® |
Treatment of invasive aspergillosis, candidemia in nonneutropenic patients, and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds
Treatment of esophageal candidiasis, serious fungal infections caused by Scedosporium apiospermum (asexual form of Pseudallescheria
boydii) and Fusarium spp., including Fusarium solani, in patients intolerant of or refractory to other
therapy |
Prophylaxis of invasive Aspergillus and Candida infections in
patients who are at high risk of developing these infections because of being severely immunocompromised,
such as HSCT recipients with GVHD or those with
hematologic malignancies with prolonged neutropenia from chemotherapy |
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