[Prophylactic and empirical treatment of mycoses in neutropenic fever. Report and comments on meta-analysis].
Patients treated for cancer with chemotherapy and other cytoreductive therapy often develop serious bacterial, viral, and fungal infections due to B- and T-cell depletion, neutropenia and decreased barrier function of mucosal membranes. In patients with neutropenic fever not responding to broad spectrum antibiotic therapy there is a high risk of fungal infection. In a Cochrane Library meta-analysis of the effect of prophylactic and empirical antifungal treatment, amphotericin B was found to be the only drug affecting total mortality. Fluconazole, ketoconazole and itraconazole affected risk of colonization and invasive infection, but not the total risk of death. We agree with these conclusions, but emphasize that the appropriate time to initiate empirical antifungal therapy is still not settled. We also believe that azoles may be of value in the therapy of symptomatic mucositis.
Kalin
M
M
Infektionskliniken, Karolinska sjukhuset, Stockholm. mats.kalin@ks.se
Björkholm
M
M
D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D004352:Drug Resistance, Microbial; D019317:Evidence-Based Medicine; D005334:Fever / Q000209:etiology / Q000276:immunology*; D006801:Humans; D015201:Meta-Analysis as Topic; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D009503:Neutropenia / Q000139:chemically induced / Q000276:immunology*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D000666:Amphotericin B