Fluconazole versus amphotericin B for the prevention of fungal infection in neutropenic patients with hematologic malignancy
Takatsuka, H.; Takemoto, Y.; Okamoto, T.; Fujimori, Y.; Tamura, S.; Wada, H.; Okada, M.; Kanamaru, A.; Kakishita, E.
Drugs under Experimental and Clinical Research 25(4): 193-200
1999
ISSN/ISBN: 0378-6501 PMID: 10442277 Document Number: 509883
The effectiveness of fungal prophylaxis with amphotericin B or fluconazole was investigated in 124 neutropenic patients (67 men, 57 women; aged 16-85 years) from Japan, with haematological malignancy. Data on fungal isolates, plasma (1->3)- beta -D glucan ( beta -D-glucan) levels, febrile periods (the number of days with an axillary temperature >38 degrees C), and the duration of an axillary temperature >38 degrees C when the neutrophil count was <500/ micro l. 57 patients had acute myelogenous leukaemia, 19 had acute lymphoblastic leukaemia, 18 had non-Hodgkin's lymphoma, 6 had chronic myeloid leukaemia, 3 had adult T-cell leukaemia, and 5 had chronic lymphocytic leukaemia. There were no significant differences in clinical characteristics between the 70 patients treated with amphotericin B and the 54 patients given fluconazole. There was a significant decrease of fungal isolates (P<0.001), plasma beta - glucan level (P=0.0001) and febrile period (P<0.05) in the patients given fluconazole compared with those given amphotericin B. Fungi isolated were Candida albicans (1.8% of fluconazole group, 8.3% of amphotericin B group), Torulopsis glabrata (5.5% and 12.6%), C. krusei (1.2% and 1.6%) and C. tropicalis (0.7% and 1.5%). In neutropenic patients with haematological malignancies, prophylaxis with fluconazole significantly decreased fungal isolation and other indicators of fungal infection when compared with amphotericin B. Fluconazole may therefore be more effective for fungal prophylaxis in these patients.