title: Empiric antifungal therapy in patients with febrile neutropenia.
abstract: Invasive fungal infections, most commonly candidiasis or aspergillosis, are a major cause of morbidity and mortality among patients with neutropenia. Difficulty in diagnosing invasive fungal infections in these patients complicates decisions regarding pharmacotherapy. Because of the difficult diagnosis and the significant morbidity and mortality of fungal infections in patients with neutropenia, systemic antifungal agents are used as empiric antifungal therapy in patients with febrile neutropenia who are not responding to antibacterial therapy. The pharmacotherapy of invasive fungal infections has evolved rapidly within the past several years as numerous antifungal agents--different formulations of amphotericin B, azoles, and echinocandins--have become available for use as empiric antifungal therapy in patients with febrile neutropenia. Various levels of evidence support the use of these agents for this indication. Their use is limited, however, by drug intolerance, drug interactions, adverse-event profiles, and limited activity with some mold species. Thus, considerations for selecting an antifungal drug for empiric use in patients with febrile neutropenia should include the epidemiology of fungal infections in the individual patient's institution and the specific clinical circumstances of the patient.
authors: Department of Pharmacy, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pennsylvania, USA.
authors: Jenna J
authors: JJ
authors: Ferrara
authors: Conan
authors: C
authors: MacDougall
authors: Jason C
authors: JC
authors: Gallagher
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents