Problems and controversies in the management of hematogenous candidiasis.
Hematogenous candidiasis is associated with substantial mortality and morbidity. Amphotericin B has routinely been used to treat this infection. However, tolerance of therapy with amphotericin B is limited by the drug's toxicity. The results of recently completed prospective randomized clinical studies comparing amphotericin B with fluconazole for the treatment of hematogenous candididiasis suggest that fluconazole is as effective as amphotericin B and that fluconazole is better tolerated by patients. Nevertheless, several questions remain to be answered regarding the optimal choice of antifungal agent for both nonneutropenic and neutropenic patients, the dosing schedule and duration of therapy, the role of combination antifungal therapy, and the efficacy of the lipid formulations of polyenes. Controversial issues with respect to the role of central venous catheters in the pathogenesis of hematogenous candidiasis, as well as the roles of cytokines and white blood cell transfusions in the treatment of neutropenic patients with hematogenous candidiasis, also need to be addressed.
Uzun
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Department of Medical Specialities, University of Texas M.D. Anderson Cancer Center, Houston 77005, USA.
Anaissie
E J
EJ
D000465:Algorithms; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003115:Colony-Stimulating Factors / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D017708:Leukocyte Transfusion; D008081:Liposomes; D009503:Neutropenia / Q000150:complications; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D003115:Colony-Stimulating Factors; D008081:Liposomes; D000666:Amphotericin B; D015725:Fluconazole