A multicentre study of fluconazole versus oral polyenes in the prevention of fungal infection in children with hematological or oncological malignancies

Abstract

A randomized, comparative study was conducted in 502 patients in 23 centres world-wide to assess the efficacy and safety of fluconazole versus nystatin and amphotericin B for prevention of fungal infection in a severely immunocompromised pediatric population. Patients scheduled within 48 hours to undergo chemotherapy or radiotherapy for hematological or oncological malignancies were randomly allocated to receive 3 mg/kg oral fluconazole once daily, 50,000 U/kg oral nystatin four times daily or 25 mg/kg oral amphotericin B four times daily. Prophylaxis began with the initiation of chemotherapy or radiotherapy and continued throughout a patient's hospital stay or period of neutropenia as necessary. The mean duration of fluconazole prophylaxis was 27.8 days and of the oral polyenes 29.2 days. The outcome of prophylaxis with fluconazole was significantly superior to that with the polyenes (p = 0.01). Mycologically verified infections occurred in 5 patients (2.1%) given fluconazole and in 21 (8.4%) given polyenes (p = 0.002). Clinical evaluation at the end of prophylaxis showed that the clinical outcome was definitely or possibly successful in 87% in the fluconazole group and 82% in the polyenes group with no significant differences between the treatment groups. Mycological evaluation demonstrated reduction or control of colonization in 84% in the fluconazole group and 85% in the polyenes group, again with no significant between-group differences. Possibly drug-related side effects, mainly mild to moderate gastrointestinal disturbances, were reported in 38 patients given fluconazole, with eight subsequent withdrawals, and in 21 patients given oral polyenes, with three subsequent withdrawals. Laboratory test abnormalities occurred in 28 patients given fluconazole and 24 given polyenes.(ABSTRACT TRUNCATED AT 250 WORDS)

The Effect of Gold Nano Particles Compared to Dioxide Titanium Nano Particles on Vital Factors of Isolated Candida albicans in Patients with Oral Candidiasis in Vitro

“…tion for having specific chemo-physical features [11][12][13][14][15][16][17]. Ninane found that 15% -60% of people with malignancies will develop oral candidiasis while they are immunosuppressed [18]. One of the mineral oxides that has been recently used is Titanium dioxide.…”

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

“…Prophylactic use of fluconazole in both adult [19][20][21][22] and pediatric patients with hematologic malignancies and immunodeficiencies is well established, 20,23 whereas controversial results have been observed in the few smallscale studies devoted to prophylaxis with antifungal agents in neonates. Two studies showed that oral or intravenous fluconazole 24 and oral nystatin 25,26 can prevent rectal colonization by Candida, whereas topical miconazole oral gel failed to prevent colonization and systemic infection.…”

Practical modalities for prevention of fungal infections in cancer patients

“…The same results were found in a retrospective study performed at the Detroit Medical Center (9) in which a lower dosage (100-200 mg daily) was given. Therapy with 3 mg of fluconazole per kilogram body weight ap peared to be superior to oral nystatin or ampho tericin B in 502 children treated for malignancies (10). However, the superiority of fluconazole was less evident when this agent was administered prophylactically to adults during remission in duction therapy for acute leukemia (11)(12)(13)(14).…”

“…Data from the study conducted by Goodman et al (7), in which 400 mg fluconazole was administered daily, are the most convincing, but the results from trials in which patients were treated at a lower dosage sug gest that half the dose may suffice in the majori ty of cases (10,14). Fluconazole was well tolerat ed at all dosage levels and was not associated with serious adverse effects apart from the tendency to select resistant Ctfnd/dflspp., particularly Candida krusei (15).…”

“…Fluconazole was well tolerat ed at all dosage levels and was not associated with serious adverse effects apart from the tendency to select resistant Ctfnd/dflspp., particularly Candida krusei (15). Such selection of resistance may be a local phenomenon, because it was not mentioned as a problem in other prospective, randomized studies (10,12,13). Although fluconazole offers no protection against infections by Aspergillus spp., the overall prophylactic efficacy of this drug dur ing prolonged neutropenia appeared to compare to that of low-dose intravenous amphotericin B (16).…”