From the Guidelines
Hydroxyurea should typically be temporarily discontinued during acute infections, especially if the infection is severe or accompanied by significant myelosuppression. This recommendation prioritizes minimizing the risk of worsening morbidity and mortality due to potential exacerbation of neutropenia, which is crucial for fighting infections. The decision to discontinue hydroxyurea during an acute infection is based on its mechanism of action as a myelosuppressive agent that can lower white blood cell counts 1.
When considering the management of hydroxyurea in the context of acute infections, several key points are important:
- The balance between the benefits of hydroxyurea in managing conditions like sickle cell disease and the potential harms of myelosuppression during an infection must be carefully weighed.
- The American Society of Hematology guidelines, although focused on sickle cell disease, emphasize the importance of careful monitoring and the potential benefits of hydroxyurea therapy, suggesting that its use is beneficial when managed appropriately 1.
- However, these guidelines also highlight the low certainty of evidence regarding combination therapies and the potential risks associated with hydroxyurea, particularly in the context of infections and myelosuppression.
In clinical practice, the approach to managing hydroxyurea during acute infections involves:
- Temporarily discontinuing hydroxyurea until the infection resolves and blood counts recover, to avoid exacerbating neutropenia and compromising the body's ability to fight the infection.
- Monitoring the patient's clinical status and blood counts closely to determine the appropriate time to restart hydroxyurea, if necessary.
- Consulting with the prescribing physician to make decisions based on individual patient circumstances, including the severity of the infection and the underlying condition being treated with hydroxyurea.
From the Research
Discontinuation of Hydroxyurea in Acute Infection
- The decision to discontinue hydroxyurea in the presence of an acute infection is not explicitly addressed in the provided studies 2, 3, 4, 5, 6.
- However, it is known that hydroxyurea can cause bone marrow suppression, leading to pancytopenia, which may increase the risk of infection 2.
- Study 6 investigated the relationship between hydroxyurea treatment and invasive bacterial infections in patients with sickle cell disease, but found no significant difference in infection risk between treated and untreated patients.
- The studies do provide information on the management of hydroxyurea in patients with sickle cell disease, including monitoring of blood counts and adjustment of dosages as needed 4, 5.
- In general, the management of hydroxyurea in patients with acute infections would depend on various factors, including the severity of the infection, the patient's overall health status, and the potential benefits and risks of continuing or discontinuing hydroxyurea therapy.
Considerations for Discontinuation
- Bone marrow suppression is a known side effect of hydroxyurea, which could potentially increase the risk of infection 2, 5.
- The presence of an acute infection may require careful consideration of the risks and benefits of continuing hydroxyurea therapy 6.
- Patients with sickle cell disease who are taking hydroxyurea should be closely monitored for signs of infection and other adverse effects 4, 5.