title: Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature.
abstract: We conducted a prospective, randomized, multicenter study comparing fluconazole and amphotericin B in the treatment of candidal infections. One hundred and sixty-four patients (60 of whom were neutropenic) with documented or presumed invasive candidiasis were assigned to treatment with either fluconazole (400 mg daily) or amphotericin B (25-50 mg daily; 0.67 mg/kg daily for neutropenic patients). Clinical response and survival rates were assessed at 48 hours, after 5 days, and at the end of therapy. Overall response rates to fluconazole and amphotericin B were similar (66% and 64%, respectively). There were no differences in response as related to site of infection, pathogen, time to defervescence, relapse, or survival rates between the groups. Adverse effects were more frequent with amphotericin B (35%) than with fluconazole (5%; P < .0001). The results of this study confirm that fluconazole is as effective as but better tolerated than amphotericin B in the treatment of candidal infections.
authors.affiliation: Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: R O
authors.initials: RO
authors.lastname: Darouiche
authors.forename: D
authors.initials: D
authors.lastname: Abi-Said
authors.forename: O
authors.initials: O
authors.lastname: Uzun
authors.forename: J
authors.initials: J
authors.lastname: Mera
authors.forename: L O
authors.initials: LO
authors.lastname: Gentry
authors.forename: T
authors.initials: T
authors.lastname: Williams
authors.forename: D P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: C L
authors.initials: CL
authors.lastname: Karl
authors.forename: G P
authors.initials: GP
authors.lastname: Bodey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy*; D005260:Female; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000666:Amphotericin B; D015725:Fluconazole