Chemoprophylaxis of Fungal-infections in Granulocytopenic Patients Using Fluconazole Vs Oral Amphotericin-b

Optimal chemoprophylaxis for fungal infection is not yet well defined. This study evaluates the respective roles of oral amphotericin B and fluconazole in granulocylopenic cancer patients. Fluconazole was better tolerated and had to be discontinued in only 1 of 30 patients compared with 5 of 29 patients receiving amphotericin B. The number of febrile episodes was similar in each group, but the median duration of prophylaxis prior to the first fever episode was longer in patients receiving fluconazole (8 days) than in those receiving amphotericin B (5 days). The number of patients requiring the initiation of intravenous amphotericin B was similar in each group. Documented fungal infections occurred in 4 patients receiving fluconazole and 6 receiving amphotericin B, including 2 patients in each group who developed fungaemia. No invasive candidiasis caused by Candida albicans was observed. Although the overall mortality was similar in each group, there was only one fungal death in the fluconazole group (due to aspergillosis) compared with 3 in the amphotericin B group (due to aspergillosis or trichosporosis).