Empiric amphotericin B therapy: the need for a reappraisal.
Neutropenic patients are at high risk of developing invasive fungal diseases. A number of studies, both randomized and historical, have demonstrated that empiric therapy with amphotericin B in neutropenic patients with fever, refractory to antibiotics, results in a decrease in the frequency and mortality of deep fungal infections. Recent years have seen a number of advances in the management of neutropenic patients. Reasonably effective antifungal prophylaxis now exists and in many centres forms part of the routine care of neutropenic patients. Other centres advocate the use of selective decontamination and/or protective isolation. Furthermore the duration of neutropenia can be reduced with the use of haematopoetic growth factors. The impact of empiric amphotericin B in patients already benefiting from such treatments has not been adequately studied. The optimum dose of empiric amphotericin B is not defined. The criteria for commencing amphotericin B therapy in febrile neutropenic patients must therefore be redefined on the basis of further studies carried out in the context of these developments. We offer an approach to the use of empiric amphotericin B based on risk factors and prophylaxis.
Fraser
I S
IS
Regional Department of Infectious Diseases and Tropical Medicine, University of Manchester, North Manchester General Hospital, UK.
Denning
D W
DW
D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D005335:Fever of Unknown Origin / Q000209:etiology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007938:Leukemia / Q000150:complications; D015337:Multicenter Studies as Topic; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D009503:Neutropenia / Q000150:complications / Q000628:therapy; D010356:Patient Isolation; D016032:Randomized Controlled Trials as Topic; D012306:Risk
D007155:Immunologic Factors; D000666:Amphotericin B; D016178:Granulocyte-Macrophage Colony-Stimulating Factor