Antifungal prophylaxis

Evaluate the role of antifungal prophylaxis in the prevention of opportunistic fungal... 

Lortholary O, Dupont B Antifungal prophylaxis during neutropenia and immunodeficiency. Clin Microbiol Rev 1997 10 477-504. 

MiUiken ST, Powles RL. Antifungal prophylaxis in bone marrow transplantation. Rev Infect Dis 1990 12(Suppl 3) S374-9. 

The safety and efficacy of oral cyclodextrin itraconazole (5 mg/kg/day) as antifungal prophylaxis has been assessed in an open trial in 103 neutropenic children (median age 5 years range 0-15 years) (53). Prophylaxis was started at least 7 days before the onset of neutropenia and continued until neutrophil recovery. Of the 103 patients, only 47 completed the course of prophylaxis 27 withdrew because of poor compliance, 19 because of adverse events, and 10 for other reasons. Serious adverse events (other than death) occurred in 21 patients, including convulsions (n = 7), suspected drug interactions (n = 6), abdominal pain (n — 4), and constipation n — 4). The most common adverse events considered definitely or possibly related to itraconazole were vomiting (n = 12), abnormal liver function (n — 5), and abdominal pain (n = 3). Tolerabihty of the study medication at end-point was rated as good (55%), moderate (11%), poor (17%), or unacceptable (17%). There were no unexpected problems of safety or tolerability. 

Foot AB, Veys PA, Gibson BE. Itraconazole oral solution as antifungal prophylaxis in children undergoing stem cell transplantation or intensive chemotherapy for haematological disorders. Bone Marrow Transplant 1999 24(10) 1089-93. 

Glasmacher A, Hahn C, Molitor E, Marklein G, Sauerbruch T, Schmidt-Wolf IG. Itraconazole through concentrations in antifungal prophylaxis with six different dosing regimens using hydroxypropyl-beta-cyclodextrin oral solution or coated-pellet capsules. Mycoses 1999 42(ll-12) 591-600. 

A 19-year-old woman developed severe abdominal pain and constipation 28 days after starting to take itraconazole as antifungal prophylaxis when receiving vincristine... 

Antifungal prophylaxis does not decrease the incidence of invasive mold infections. In addition to environmental precautions, strategies being investigated for Aspergillus prophylaxis in neutropenic patients include oral itraconazole, low (0.1-0.25 mg/kg per day) to moderate (0.5 mg/kg per day) doses of amphotericin B, intranasal and aerosolized amphotericin B, and hpid-associated amphotericin B products. None of these interventions can be recommended routinely in clinical practice at this time. 

Comely OA, Ullmann AJ, Karthaus M. Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies. Blood 2003 101 3365-3372. 

Bow EJ, Laverdiere M, Lussier N, et al. Antifungal prophylaxis for severely neutropenic chemotherapy recipients A meta-analysis of randomized-controlled clinical trials. Cancer 2002 94 3230-3246. 

Winston DJ, MaziarzRT, Chandrasekar PH, etal. Intravenous and oral itraconazole versus intravenous and oral fluconazole for long-term antifungal prophylaxis in allogeneic hematopoietic stem-cell transplant recipients A multicenter, randomized trial. Ann Intern Med 2003 138 705-713. 

Marr KA. Antifungal prophylaxis in hematopoitec stem cell transplant recipients. Curr Opin Infect Dis 2001 14 423M26. 

Gubbins PO, Bowman JL, Penzak SR. Antifungal prophylaxis to prevent invasive mycoses among bone marrow transplantation patients. Pharmacotherapy 1998 18 549-564. 

Four out of 14 patients with ALL given induetion chemotherapy with weekly injections of vincristine (with prednisone, daunorubicin and asparaginase) and antifungal prophylaxis with itraconazole 400 mg daily, developed severe and early vincristine-induced neurotoxicity (paraesthe-sia and muscle weakness of the hands and feet, paralytic ileus, mild laryngeal nerve paralysis). The degree and early onset of these neurotoxic reactions were unusual, and were all reversible except for mild paraesthe-sia in one patient. The complications were more serious than in a previous... 

Uzun O, Anaissie EJ (1995) Antifungal prophylaxis in patients with hematologic malignancies a reappraisal. Blood 86 2063-2072... 

Observational studies Of 72 patients undergoing allogeneic transplantation who were given voriconazole as antifungal prophylaxis starting from 2 days before transplantation and continuing until withdrawal of immunosuppression, 10 required interruption of voriconazole therapy because of adverse effects hepatotoxicity ( = 6), QT interval prolongation (n = 1), or other adverse effects ( = 4) [68]. 

Cadena J, Levine DJ, Angel LF, Maxwell PR, Brady R, Sanchez JF, Michalek JE, Levine SM, Restrepo MI. Antifungal prophylaxis with voriconazole or itraconazole in lung transplant recipients hepatotoxicity and effectiveness. Am J Transplant 2009 9 2085-91. 

Hiramatsu Y, Maeda Y, Fujii N, Saito T, Nawa Y, Hara M, Yano T, Asakura S, Sunami K, Tabayashi T, Miyata A, Matsuoka K, Shinagawa K, Ikeda K, Matsuo K, Tanimoto M. West-Japan Hema-tolc and Oncology Group. Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation. Int J Hematol 2008 88 588-95. 

Kusuki S, Hashii Y, Yoshida H, Takizawa S, Sato E, Tokimasa S, Ohta H, Ozono K. Antifungal prophylaxis with micafungin in patients treated for childhood cancer. Pediatr Blood Cancer 2009 53 605-9. 

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