Fluconazole is a new orally absorbed antifungal
azole which is effective in the treatment of mucosal and systemic
infections caused by Candida, cryptococci and other fungi. In view of its favourable efficacy, safety and pharmacokinetic profile it was considered appropriate to evaluate its use prophylactically in patients undergoing a period of
neutropenia. Two hundred and forty-eight patients receiving
chemotherapy and/or
bone marrow transplantation for the treatment of acute leukaemia,
lymphoma or
aplastic anaemia, and expected to be rendered temporarily neutropenic, have been entered into an ongoing multicentre comparative clinical study to compare the prophylactic efficacy of 50 mg daily oral
fluconazole with that of widely used regimens of oral
polyenes. The incidence of suspected
fungal infection was less in the
fluconazole group (27%) than in the polyene group (45%), the difference being statistically significant (P less than 0.05). Only one of the suspected
infections in the
fluconazole group was confirmed mycologically compared with 17 in the polyene group.
Fluconazole prophylaxis was well tolerated and it therefore offers a promising new approach to the management of
fungal infection in the neutropenic patient. Further studies are warranted to define the optimum dosage for use in this situation.