Itraconazole prophylaxis for invasive gingival aspergillosis in neutropenic patients with acute leukemia.
BACKGROUND
Due to an increasing number of leukemic patients with invasive gingival aspergillosis during neutropenia (neutrophils <500 cells/microl for >10 days), we evaluated the efficacy of oral itraconazole prophylaxis for preventing this invasive infection at our hospital.


METHODS
This was a retrospective, non-randomized study to analyze the onset of identified invasive gingival aspergillosis among 536 patients with acute leukemia at risk due to the presence of neutropenia from 1991 to 1998. Patients received itraconazole capsules 100 mg/day prophylactically between April 1994 and December 1996, and 200 mg/day between January 1997 and December 1998. Itraconazole serum levels at day 10 were measured in some patients.


RESULTS
In the 39 months prior to April 1994 without itraconazole prophylaxis, 15 cases of invasive gingival aspergillosis were detected in 192 high risk patients with 469 episodes of neutropenia (7.8% of the high risk patients). Between April 1994 and December 1996, using itraconazole prophylaxis at 100 mg/day, there was a dramatic decrease in the infections resulting in 3 of 198 high risk patients with 511 episodes of neutropenia (1.5% of the high risk patients). Furthermore, between January 1997 and December 1998, using itraconazole prophylaxis at 200 mg/day, no cases of the infection were observed in the 146 high risk patients with 380 episodes of neutropenia. The incidence of invasive gingival aspergillosis was significantly lower among patients administered itraconazole than among those without itraconazole (100 mg/day; P = 0.006 and 200 mg/day; P = 0.001). The mean itraconazole serum level in 20 patients receiving 100 mg/day was 71.78 ng/mL and in 16 patients receiving 200 mg/day was 202.67 ng/ml.


CONCLUSIONS
These findings suggest that oral itraconazole could be effective for preventing invasive gingival aspergillosis in neutropenic patients with acute leukemia and warrants further randomized investigation.
Myoken
Yoshinari
Y
Department of Oral Surgery, Hiroshima Red Cross and Atomic Bomb Survivors Hospital, Japan. myoken@do5.enjoy.ne.jp
Sugata
Tatsumi
T
Kyo
Tai-ichi
T
Fujihara
Megumu
M
Mikami
Yuzuru
Y
D000284:Administration, Oral; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000517:prevention & control*; D002180:Candidiasis, Oral / Q000517:prevention & control; D002214:Capsules; D016009:Chi-Square Distribution; D002851:Chromatography, High Pressure Liquid; D015331:Cohort Studies; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D005882:Gingival Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D007958:Leukocyte Count; D009503:Neutropenia / Q000150:complications*; D009504:Neutrophils / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D002214:Capsules; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine