Le métronidazole (Flagyl) reste la référence dans le traitement des infections anaérobies et des parasitoses comme la giardiase ou l’amibiase. Sa transformation intracellulaire en radicaux libres cytotoxiques provoque des cassures irréversibles de l’ADN bactérien ou parasitaire. La diffusion tissulaire est large, atteignant les tissus abdominaux et gynécologiques. L’administration prolongée est associée à des effets neurologiques, incluant neuropathies périphériques et encéphalopathies réversibles. L’association avec l’alcool déclenche une réaction de type antabuse. Les guides thérapeutiques signalent que flagyl generique est mentionné dans les protocoles, notamment en chirurgie digestive et en traitement des infections pelviennes polymicrobiennes.

Contents

Department of Medical Oncology
Chemotherapy Protocols
Fludarabine
Indications: “Low Grade” non-Hodgkin’s Lymphoma and CLL Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Prophylactic co-trimoxazole and valaciclovir • Round Fludarabine to the nearest 10mg Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, amenorrhoea, pneumonitis, carcinogenesis, infertility, hair thinning, fluid retention Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment • U &E’s, LFTs, creatinine, urate • Staging investigations as per protocol Review in the Medical Oncology Clinic 4 weeks after last cycle et al, 1999. J. Clin. Oncol., 17; pages 546-553 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
“Low Grade” non-Hodgkin’s lymphoma and CLL Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle Rosenberg SA, 1985. J. Clin. Oncol., 3; pages 299-310 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
“Low Grade” non-Hodgkin’s lymphoma and CLL Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2005. Blood, 105; pages 1417-1423 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: “Low Grade” non-Hodgkin’s Lymphoma Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils - < 1.0 x 109/L or platelets < 100 x 109/L • Prophylactic co-trimoxazole and valaciclovir Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, encephalopathy, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2000. Ann. Oncol., 11; pages 861-865 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 1991. J. Clin. Oncol., 9; pages 211-219 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: Non-Hodgkin’s Lymphoma (B-cell) Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately High • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Rituximab should be given pre-CHOP on cycle 1, subsequent cycles the order • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab Symptomatic treatment of side effects: Mouth care encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2002. N. Engl. J. Med., 346; pages 235-242 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
CHOP-R (with Intrathecal Methotrexate)
Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately High • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Intrathecal methotrexate to be given in accordance with local policy • Rituximab should be given pre-CHOP on cycle 1, subsequent cycles the order • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab, post-lumbar puncture headache, meningeal irritation Symptomatic treatment of side effects: Mouth care encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2002. N. Engl. J. Med., 346; pages 235-242 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
PIE (Cisplatin/Ifosfamide/Etoposide)
Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre & post hydration, mannitol, potassium & magnesium • Mesna dose guidelines Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
R-ICE (Carboplatin/Ifosfamide/Etoposide)
Ifosfamide 5,000mg/m2 1L N. Saline/24 hrs Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function, hydration • Prophylactic pegylated G-CSF on day 5 • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Kewalramani et al, 2004. Blood, 103; pages 3684-3688
3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Dose modification: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high on days 1 and 15 • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Round Etoposide dose to the nearest 50mg Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in the Medical Oncology Clinic 4 weeks after last cycle et al, 1994. Ann. Oncol., 5; pages 147-155 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Rituximab (Mabthera)
Dose modification: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, hyper-sensitivity reaction, carcinogenesis, infertility, allergic-like reaction, bronchospasm, hypotension, cardiotoxicity, chills/fevers, rigors Symptomatic treatment of side effects: Supportive therapy Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 1999. J. Clin. Oncol., 17; pages 1851-1857 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: Recurrent lymphoma and Hodgkin’s disease Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L • Pre & post hydration, mannitol, potassium & magnesium • Double/triple lumen Hickman line required Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, conjunctivitis, alopecia, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, red skin, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol inc. CT scans • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Velasquez et al, 1994. J. Clin. Oncol., 12; pages 1169-1176
3rd Edition

Source: http://www.midwesterncancercentre.ie/protocols/NonHodkinsChemoProtocols.pdf