Antifungal prophylaxis with low-dose fluconazole during bone marrow transplantation. The Bone Marrow Transplantation Team.

Abstract

The present study investigated the prophylactic efficacy of fluconazole at 100-200 mg/day against invasive fungal infections during bone marrow transplantation (BMT). During July 1990 to December 1991, all BMT recipients received antifungal prophylaxis with fluconazole at either 200 mg/day or 100 mg/day. Historical controls were those that received no antifungal prophylaxis (January 1989 to June 1990). Fungemia occurred in 4 of 112 fluconazole recipients and 8 of 79 controls (p < 0.05) prior to engraftment. Torulopsis (Candida) glabrata (three patients), Cryptococcus terreus and Candida tropicalis (mixed in one patient) caused fungemia in four patients in the fluconazole group; Candida albicans caused six of eight fungemic episodes in the controls. All three Torulopsis glabrata isolates were fluconazole-resistant. Colonization due to C. albicans was markedly diminished in the fluconazole group (19 of 112 patients versus 53 of 79 controls). T. glabrata, on the other hand, was a more common colonizing organism in the fluconazole group (36 of 112 vs 10 of 79). The frequency of isolating C. albicans and/or T. glabrata was significantly different between fluconazole and control groups (p < 0.0001). Empiric use of amphotericin B therapy was markedly reduced in the fluconazole group (4.5% vs 34%; p < 0.0001). Fluconazole at 200 mg/day or 100 mg/day appeared equally effective. Fluconazole at a daily dose of 100 mg or 200 mg as antifungal prophylaxis during BMT: (1) significantly reduced the frequency of systemic fungal infections, (2) markedly reduced colonization and infection due to C. albicans, and (3) markedly reduced the need for empiric amphotericin B therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: G Alangaden, P H Chandrasekar, E Bailey, Y Khaliq
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 14 Issue 6 Pg. 919-24 (Dec 1994) ISSN: 0268-3369 [Print] England
• PMID: 7711669 (Publication Type: Journal Article)

Chemical References

• Fluconazole

Topics

• Adolescent
• Adult
• Aged
• Bone Marrow Transplantation (methods)
• Candida
• Candida albicans
• Dose-Response Relationship, Drug
• Female
• Fluconazole (administration & dosage)
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Mycoses (prevention & control)
• Retrospective Studies