Candidiasis: Fuconazole 400 mg/day, has been shown to be better than placebo in preventing both superficial and systemic fungal infections in marrow recipients and, in lesser degree, in neutropenic patients with acute leukemia. Lower dose of fluconazole (150 mg/day) have been shown to have similar efficacy when compared to oral amphotericin B in preventing superficial and systemic fungal infections in patients with acute leukemia . The prophylactic use of fluconazole has been associated with the emergence of C. krusei infections. ltraconazole oral solution has been shown to reduce fungemia due to Candida spp. and their related mortality in pts with haematological malignancies.Fluconazole or ltraconazole oral solution may be considered for the prevention of candidiasis in haematological patients with severe and persistent neutropenia. Weekly surveillance throat and stool cultures might help to select high-risk patients colonized with Candida species susceptible to azoles.Aspergillosis: HEPA filters has been shown to prevent aspergillosis in patients undergoing bone marrow transplantation. Intranasal or aerosol administration of amphotericin B and low-dose i.v. amphotericin B have been shown to be mainly uneffective in preventing invasive pulmonary aspergillosis. ltraconazole oral solution seems to reduce deep aspergillosis but the results of three major RCT were not statistically significant.The use of HEPA filters is the only strategy with proven efficacy against primary aspergillosis. Amphotericin B combined with 5~fiucytosine has been shown to effectively prevent relapse of aspergillosis during new episodes of neutropenia.
Full conference title:
5th Trends in Invasive and Fungal Infections
- TIFI 5th