Fluconazole vs. Amphotericin B for the Treatment of Neonatal Fungal Septicemia: A Prospective Randomized Trial

Driessen, M.; Ellis, J.; Cooper, Peter; Wainer, Stephen; Muwazi, Faith; Hahn, Deirdré; Gous, Hermien; Villiers, F. P. R. De

doi:10.1097/00006454-199612000-00011

Cited by 157 publications

(66 citation statements)

References 16 publications

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“…In contrast to the percentage of resistant isolates observed in 1992 to 2001 for isolates from this age group (7%) (63), 27% of the current isolates were resistant to fluconazole. This increased resistance may reflect the increased use of fluconazole prophylaxis and treatment in these groups of younger patients (12,27,49,57,58). Whereas the proportion of BSI isolates of Candida that were C. glabrata increased with patient age, the rate of fluconazole resistance declined (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Variation in Susceptibility of Bloodstream Isolates ofCandida glabratato Fluconazole According to Patient Age and Geographic Location in the United States in 2001 to 2007

et al. 2009

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We examined the susceptibilities to fluconazole of 642 bloodstream infection (BSI) isolates of Candida glabrata and grouped the isolates by patient age and geographic location within the United States. Susceptibility of C. glabrata to fluconazole was lowest in the northeast region (46%) and was highest in the west (76%). The frequencies of isolation and of fluconazole resistance among C. glabrata BSI isolates were higher in the present study (years 2001 to 2007) than in a previous study conducted from 1992 to 2001. Whereas the frequency of C. glabrata increased with patient age, the rate of fluconazole resistance declined. The oldest age group (>80 years) had the highest proportion of BSI isolates that were C. glabrata (32%) and the lowest rate of fluconazole resistance (5%).Candidemia is without question the most important of the invasive mycoses (6,33,35,61,65,68,78,86,88). Treatment of candidemia over the past 20 years has been enhanced considerably by the introduction of fluconazole in 1990 (7, 10, 15, 28, 29, 31, 40, 56-58, 61, 86, 90). Because of its widespread usage, concern about the development of fluconazole resistance among Candida spp. abounds (2,6,14,32,47,53,55,56,59,60,62,80,86). Despite these concerns, fluconazole resistance is relatively uncommon among most species of Candida causing bloodstream infections (BSI) (5,6,22,24,33,42,54,56,65,68,71,86). The exception to this statement is Candida glabrata, of which more than 10% of BSI isolates may be highly resistant (MIC Ն 64 g/ml) to fluconazole (6, 9, 15, 23, 30, 32, 36, 63-65, 71, 87, 91). Suboptimal fluconazole dosing practices (low dose [Ͻ400 mg/day] and poor indications) may lead to an increased frequency of isolation of C. glabrata as an etiological agent of candidemia in hospitalized patients (6,17,29,32,35,41,47,55,60,68,85) and to increased fluconazole (and other azole) resistance secondary to induction of CDR efflux pumps (2,11,13,16,43,47,50,55,69,77,83,84) and may adversely affect the survival of treated patients (7,10,29,40,59,90). Among the various Candida species, C. glabrata alone has increased as a cause of BSI in U.S. intensive care units since 1993 (89). Within the United States, the proportion of fungemias due to C. glabrata has been shown to vary from 11% to 37% across the different regions (west, midwest, northeast, and south) of the country (63, 65) and from Ͻ10% to Ͼ30% within single institutions over the course of several years (9, 48). It has been shown that the prevalence of C. glabrata as a cause of BSI is potentially related to many disparate factors in addition to fluconazole exposure, including geographic characteristics (3, 6, 63-65, 71, 88), patient age (5,6,25,35,41,42,48,63,82,92), and other characteristics of the patient population studied (1, 32, 35, 51). Because C. glabrata is relatively resistant to fluconazole, the frequency with which it causes BSI has important implications for therapy (21,29,32,40,41,45,56,57,59,80,81,86,90).Previously, we examined the susceptibilities to fluconazole of 559 BSI isolates ...

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Section: Resultsmentioning

confidence: 99%

Variation in Susceptibility of Bloodstream Isolates ofCandida glabratato Fluconazole According to Patient Age and Geographic Location in the United States in 2001 to 2007

et al. 2009

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“…Several studies support the use of fluconazole as preferred therapy in the treatment of systemic infections caused by Candida albicans [5,19,20,21]. In cases of poorly susceptible Candida species like C. krusei or C. glabrata, amphotericin B is the drug of first choice.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of sequential intravenous and enteral fluconazole in critically ill surgical patients with invasive mycoses and compromised gastro-intestinal function

et al. 2001

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“…The only randomised controlled trial (RCT) comparing azoles to amphotericin B for the treatment of IC in children is a trial of 23 neonates with candidaemia. 47 Patients were randomised to receive AmB-D 1 mg/kg/day or fluconazole 5 mg/kg/day, with no reported difference in outcomes. A 2010 Cochrane review of the treatment of suspected (prolonged fever and neutropenia) and proven IC identified four RCTs comparing AmB-D with lipid formulations of amphotericin and one trial comparing itraconazole with fluconazole for candidaemia.…”

Section: Treatment Of Invasive Candidiasis and Candidaemiamentioning

confidence: 99%

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Chen

Sorrell

Chang

et al. 2014

Internal Medicine Journal

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Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'preemptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).

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Fluconazole vs. Amphotericin B for the Treatment of Neonatal Fungal Septicemia: A Prospective Randomized Trial

Abstract: Fluconazole showed fewer side effects than amphotericin B and was more convenient to use.

Cited by 157 publications

References 16 publications

Variation in Susceptibility of Bloodstream Isolates ofCandida glabratato Fluconazole According to Patient Age and Geographic Location in the United States in 2001 to 2007

Variation in Susceptibility of Bloodstream Isolates ofCandida glabratato Fluconazole According to Patient Age and Geographic Location in the United States in 2001 to 2007

Pharmacokinetics of sequential intravenous and enteral fluconazole in critically ill surgical patients with invasive mycoses and compromised gastro-intestinal function

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

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