Background: There is still no consensus on the efficacy of antifungal prophylaxis in neutropenic patients after more than 50 clinical trials.
Methods: This review evaluates the current evidence from all available meta-analyses of the use of intravenous amphotericin B, fluconazole and itraconazole for this indication.
Results: Four systematic reviews with meta-analysis and one evidence-based review without meta-analysis were evaluated. Efficacy of fluconazole has been shown on short-term follow-up after allogeneic stem cell transplantation but only itraconazole was effective in neutropenic patients with haematological malignancies for prolonged prophylaxis after allogeneic stem cell transplantation. Direct comparison between fluconazole and itraconazole for this indication shows the superiority of itraconazole which was the only drug able to prevent invasive Aspergillus infections in our previously published meta-analysis of 13 trials and 3597 patients. Efficacy of itraconazole correlates closely with its dose; an effect was seen only in clinical trials using at least 400 mg/day oral solution or 200 mg/day intravenous solution. With this dose, invasive fungal infections were reduced by 53% and mortality from invasive fungal infections was reduced by 47% (P<0.05). Toxicity of itraconazole is rare and usually not severe and drug interactions are easily manageable.
Conclusions: Itraconazole is recommended for antifungal prophylaxis in high-risk neutropenic patients with haematological malignancies or for prolonged prophylaxis after allogeneic stem cell transplantation based on unambiguous evidence of efficacy and low toxicity from clinical trials and systematic reviews.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1093/jac/dki221 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
[Graft-versus-host disease-like gastroenteritis after autologous stem cell transplantation with busulfan/thiotepa conditioning for primary central nervous system lymphoma].
Rinsho Ketsueki
January 2025
Department of Hematology, Graduate School of Medicine, Kyoto University.
Graft-versus-host disease (GVHD) is less common in autologous stem cell transplantation (ASCT) recipients than in allogeneic SCT recipients. However, some cases of severe GVHD, especially involving the gastrointestinal (GI) tract, have been documented. We present a patient with primary central nervous system lymphoma (PCNSL) exhibiting severe GI-GVHD after ASCT with busulfan/thiotepa conditioning.
View Article and Find Full Text PDFMagnusiomyces capitatus, an Unusual Cause of Invasive Fungal Infections in Neutropenic Patients: Case Reports and Outbreak Investigation.
Mycopathologia
January 2025
Department of Clinical Microbiology, St. James Hospital, Dublin, Ireland.
Magnusiomyces capitatus is an environmental fungus found in soil, water, air, plants, and dairy products which may cause opportunistic infections in patients with haematological disorders resulting in high mortality rates. This series of the first reported cases in Ireland discusses investigation of two patients with underlying haematological disorders, hospitalised in the Irish National Adult Stem Cell Transplant Unit (NASCTU), who developed line-related fungaemias with M. capitatus within a three-month period.
View Article and Find Full Text PDFIntestinal icrobiota Transplant Prior to llogeneic tem Cell ransplant (MAST) trial: study protocol for a multicentre, double-blinded, placebo-controlled, phase IIa trial.
BMJ Open
December 2024
Centre for Haematology, Department of immunology and inflammation, Faculty of Medicine, Imperial College London, London, UK.
Introduction: Lower diversity of the gut microbiome prior to allogeneic haematopoietic cell transplantation (HCT) correlates with reduced survival after the intervention. Most patients undergoing HCT for a haematological malignancy have previously received intensive chemotherapy, resulting in prolonged neutropenic episodes requiring broad-spectrum antibiotics; use of these has been linked to reduced microbiome diversity. Intestinal microbiota transplant (IMT) is a novel treatment approach that restores this diversity.
View Article and Find Full Text PDFAssessing the Theoretical Efficacy of Combination Therapy Against Gram-Negative Infections in Neutropenic Pediatric Cancer Patients: Insights from the Statistical Analysis of Survey Data.
Antibiotics (Basel)
December 2024
Infectious Diseases Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital, 48149 Muenster, Germany.
: Empirical antibacterial therapy for febrile neutropenia reduces mortality due to Gram-negative blood stream infections (BSIs). Pediatric guidelines recommend monotherapy with an antipseudomonal beta-lactam or a carbapenem and to add a second anti-Gram-negative agent in selected situations. We evaluated the changes in the proportions of resistance of beta-lactam monotherapies vs.
View Article and Find Full Text PDFA Novel, Nonaquatic Zoonotic Transmission of .
Case Rep Infect Dis
December 2024
Department of Dermatology, North Bristol NHS Trust, Bristol, UK.
was first described in humans in 1954, known to infect fish species and contaminate water and fish products. Inoculation to humans occurs through injured skin resulting in the formation of a solitary nodule known as "fish tank granuloma." Disseminated infections have been reported in the immunocompromised and can present with extracutaneous manifestations such as arthritis and osteomyelitis.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!