Efficacy of different prophylactic antifungal regimens in bone marrow transplantation.
BACKGROUND
Fungal infections still represent a major clinical problem in neutropenic patients; the recent availability of active imidazole derivatives, particularly fluconazole and itraconazole, has increased interest in prophylaxis.


METHODS
Fifty-nine consecutive bone marrow transplant (BMT) recipients were randomized to receive either itraconazole 400 mg/day or fluconazole 300 mg/day as oral antimycotic prophylaxis during the pancytopenic phase; they were retrospectively compared with a historical control group of 30 patients who had received fluconazole 50 mg/day. Every febrile episode was treated with the same empirical antibiotic combination; amphotericin-B was added after 4-5 days in the case of persistent fever. Proven or suspected mycotic infections and the empirical use of amphotericin-B were considered as failures of prophylaxis.


RESULTS
There were no differences in the number of febrile episodes in the three groups. Five patient died of bacterial sepsis: two in the fluconazole 300, two in the itraconazole and one in the fluconazole 50 group. The addition of amphotericin-B was required in 12, 16 and 11 cases, respectively, in the three groups. There were four documented fungal infections in the intraconazole and one in both fluconazole groups; three suspected fungal infections were observed in the fluconazole 300 group and two in both the itraconazole and the fluconazole 50 group. None of the differences were statistically significant.


CONCLUSIONS
The present results indicate that high-dose fluconazole and itraconazole are equivalent; neither of them was superior to low-dose fluconazole, which is regarded as being devoid of prophylactic activity against systemic mycoses.
Annaloro
C
C
Centro Trapianti di Midollo, Ospedale Maggiore di Milano, I.R.C.C.S., Università degli Studi di Milano, Italy.
Oriana
A
A
Tagliaferri
E
E
Bertolli
V
V
Della Volpe
A
A
Soligo
D
D
Ibatici
A
A
Pozzoli
E
E
Lambertenghi Deliliers
G L
GL
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*
D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole