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Preemptive Ganciclovir Therapy in Renal Transplantation
- Daniel C. Brennan, MD;
- Gregory A. Storch, MD; and
- Bruce J. Lippman, MD
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TO THE EDITOR:
Hibberd and colleagues [1] recently showed that administration of ganciclovir during antilymphocyte therapy in renal transplant recipients who tested positive for cytomegalovirus (CMV) antibody decreased the incidence of CMV disease. They called this treatment strategy “preemptive therapy.” We believe that a more accurate term would have been “selected prophylactic therapy.”
The term “prophylaxis” connotes the use of an agent to prevent disease in patients at risk when no evidence suggests the imminent development of that disease. Thus, we use antibiotics for endocarditis prophylaxis when a patient with a heart murmur (but no overt evidence of bacteremia) has an invasive procedure. The term “preemptive” is most often used in military parlance when the risk for an event is imminent or in the early stages of development. For example, a “preemptive strike” was used against the Iraqis during the Persian Gulf war when military surveillance identified the presence of missile sites. A “prophylactic strike” would have been one in which all the Iraqi machine factories were attacked because they had the capability of missile production, although no missiles had been detected. Truly preemptive therapy for CMV has already been shown to be useful in bone marrow transplant recipients who began receiving ganciclovir early on the basis of detection of CMV excretion by culture of throat swabs, blood, urine, or bronchoalveolar lavage fluid [2, 3].
We suggest that the term “preemptive therapy” be reserved for patients with evidence of active but asymptomatic CMV infection who receive anti-CMV therapy [2, 3]. The phrase “selected prophylactic therapy” should be applied to the clinical situation described by Hibberd and associates [1]. We believe this term to be philologically and clinically more accurate.
p>Daniel C. Brennan, MD
Gregory A. Storch, MD
Bruce J. Lippman, MD
Washington University School of Medicine
St. Louis, MO 63110
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
