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Cited by 106Antifungal resistance and susceptibilityNeutropenia and Cancer InfectionsFungal Infections and Studies

A randomized comparison of fluconazole with amphotericin B as empiric anti-fungal agents in cancer patients with prolonged fever and neutropenia

Malik, Imtiaz A, Moid, Imran, Aziz, Zeba, Khan, Shireen, Suleman, Mohammad·1998·The American Journal of Medicine
DOI 10.1016/s0002-9343(98)00326-x
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Abstract

Purpose Several studies have documented the efficacy of amphotericin B as empiric antifungal therapy in cancer patients with prolonged fever and neutropenia. Amphotericin, however, is a toxic drug. Fluconazole has broad-spectrum antifungal activity with an excellent safety profile. Although prophylactic use of fluconazole is widespread, its efficacy as an empiric antifungal agent has not been extensively investigated.Patients and methods We randomly assigned 106 patients with absolute neutropenia (< or = 500 cells microL) and persistent fever of undetermined origin (> 38 degrees C) despite 1 week of broad-spectrum antibiotic therapy to receive either fluconazole 400 mg orally daily or amphotericin B 0.5 mg/kg/day. Patients with obvious invasive fungal infections were excluded, as were those with abnormal renal or hepatic function. Success was defined as defervescence with the initially assigned antifungal regimen without development of clinically evident invasive fungal infection.Results Six patients were excluded from the analysis, mostly because they did not have severe neutropenia. Forty-eight patients received amphotericin B, and 52 received fluconazole. Baseline clinical characteristics and laboratory parameters as well as duration of neutropenia (7.7 versus 6.9 days), duration of fever (7.8 versus 8.1 days), and duration of hospitalization (10.4 versus 8.3 days) were similar between those receiving amphotericin and fluconazole. Treatment success rates and mortality rates were similar in the two groups: 22 (46%) patients in the amphotericin group and 29 (56%) patients in the fluconazole group responded successfully to therapy (P = 0.3), whereas 16 (33%) patients in the amphotericin group and 14 (27%) patients in the fluconazole group died during hospitalization (P = 0.5). Adverse events such as chills and fever (4 versus 1), bronchospasm (2 versus none), severe hypokalemia (25 versus 12) and nephrotoxicity (9 versus 3) were more frequently observed in patients receiving amphotericin. Adverse prognostic factors included prolonged duration of neutropenia and pneumonia.Conclusions These results suggest that fluconazole is an equally effective but less toxic alternative to amphotericin B as empiric antifungal therapy in cancer patients with prolonged fever and neutropenia.

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Crossref · 10.1016/s0002-9343(98)00326-x

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  • Fluconazole (400 mg/day) has been used successfully for selected neutropenic patients.

    “Fluconazole (400 mg/day) has been used successfully for selected patients (A-I) [156-158]”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [156]

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Authors
Malik, I. A., Moid, I., Aziz, Z., Khan, S., & Suleman, M.
Affiliations
Shaikh Zayed Hospital (PK)
Corresponding author
Malik, Imtiaz A
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1998-12
Volume
105
Issue
6
Pages
478-483
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/s0002-9343(98)00326-x
OpenAlex
W2006530253
Cited by
106
References
43
Citations by year
2024: 1 · 2023: 1 · 2022: 1 · 2019: 1 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 1 · 2012: 7
FWCI
3.77
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords
fluconazole, amphotericin B, empirical antifungal therapy, cancer patients, neutropenia, persistent fever, febrile neutropenia, antifungal toxicity, nephrotoxicity, hypokalemia, prognostic factors, pneumonia, treatment efficacy, mortality, neutropenia duration, fever duration, length of hospital stay, defervescence
MeSH terms
Adolescent, Adult, Amphotericin B, Antifungal Agents, Female, Fever, Humans, Male, Middle Aged, Mycoses, Neoplasms, Neutropenia, Fluconazole, Treatment Outcome

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