Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation--a prospective, randomized, double-blind study.
A randomized, double-blind, placebo-controlled trial assessed the efficacy and toxicity of 400 mg/day fluconazole in preventing fungal infections during the first 75 days after marrow transplantation. During prophylaxis, systemic fungal infections occurred in 10 (7%) of 152 fluconazole-treated patients compared with 26 (18%) of 148 placebo-treated patients (P = .004). There were no Candida albicans infections in fluconazole recipients compared with 18 in placebo recipients (P < .001) and no significant increase in Candida infections other than C. albicans. Fluconazole also significantly reduced the incidence of superficial fungal infections (P < .001), fungal colonization (P = .037), and empiric amphotericin B use (P = .005). The probability of survival was improved in fluconazole recipients, in whom 31 deaths occurred up to day 110 after transplantation compared with 52 deaths in placebo recipients (P = .004). No clinically significant toxicity was detected with fluconazole use. Prophylactic fluconazole was safe and significantly reduced systemic fungal infections with other benefits, including improved survival at day 110 after marrow transplantation.
Slavin
M A
MA
Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
Osborne
B
B
Adams
R
R
Levenstein
M J
MJ
Schoch
H G
HG
Feldman
A R
AR
Meyers
J D
JD
Bowden
R A
RA
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000379:methods*; D002175:Candida / Q000472:pathogenicity*; D002177:Candidiasis / Q000517:prevention & control*; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000517:prevention & control; D010349:Patient Compliance; D011446:Prospective Studies; D016019:Survival Analysis
D000666:Amphotericin B; D015725:Fluconazole