Empirical Antifungal Therapy in Treating Febrile Neutropenic Patients

Wingard, John R.
July 2004
Clinical Infectious Diseases;7/15/2004 Supplement 1, Vol. 39, pS38
Academic Journal
Persistent or recurrent unexplained fever in neutropenic patients receiving antibiotics can be caused by invasive fungal infections, which are often difficult to diagnose. Early trials of empirical antifungal therapy with amphotericin B deoxycholate (AmB) documented reductions in the frequency of and the morbidity and mortality associated with invasive fungal infections. Because of AmB's infusional and renal toxicities, subsequent trials used newer, less toxic agents, such as the lipid formulations of AmB, the extended-spectrum azoles, and, more recently, the echinocandins. To date, alternatives to AmB have shown less toxicity, but improved efficacy has been less clear. Overall, empirical antifungal therapy can help prevent the morbidity associated with many fungal infections, eliminate concerns about diagnostic pitfalls, and prevent breakthrough undetected infections. However, its potential shortcomings are overtreatment, toxicity, and increased treatment-related costs when treatment is given to persons not needing it. Newer diagnostic tools are needed to target those most in need of antifungal therapy.


Related Articles

  • Antimicóticos de uso sistémico: ¿Con que opciones terapéuticas contamos? G., ANA MARÍA RIVAS; CARDONA-CASTRO, NORA // CES Medicina;2009, Vol. 23 Issue 1, p61 

    The prevalence of invasive fungal infections has increased over the past three decades owing to the increasing numbers of immunocompromised hosts. For many years, amphotericin B and flucytosine were the only available antifungal agents for invasive fungal infections. Fortunately, the antifungal...

  • Combination Antifungal Therapy for Invasive Aspergillosis: Utilizing New Targeting Strategies. Steinbach, William J. // Current Drug Targets - Infectious Disorders;Sep2005, Vol. 5 Issue 3, p203 

    The optimal therapy for invasive aspergillosis (IA) is unknown, and there is little agreement on the exact antifungal management of IA. The previously stagnant landscape of antifungal choices for IA is rapidly changing with newer antifungals and newer targets. While amphotericin B has...

  • Adverse effects of antifungal therapies in invasive fungal infections: review and meta-analysis. Girois, S. B.; Chapuis, F.; Decullier, E.; Revol, B. G. P. // European Journal of Clinical Microbiology & Infectious Diseases;Feb2006, Vol. 25 Issue 2, p138 

    Amphotericin B is the main therapeutic agent for the treatment of invasive fungal infections; however, it is associated with significant toxicities that limit its use. Other systemic antifungal agents have been developed to improve tolerability while maintaining the efficacy profile of...

  • High rate of breakthrough invasive aspergillosis among patients receiving caspofungin for persistent fever and neutropenia. Lafaurie, M.; Lapalu, J.; Raffoux, E. // Journal of Invasive Fungal Infections;2010, Vol. 4 Issue 4, p150 

    In this study, the authors sought to determine the efficacy of antifungal agents for preventing breakthrough invasive aspergillosis (IA) in a cohort of patients with persistent fever and neutropenia who received empirical antifungal therapy. Caspofungin was the most prescribed antifungal agent,...

  • The new antifungals-- safe and effective. Gallagher, Jason C.; Kauffman, Carol A.; Perfect, John // Patient Care;Jun2005, Vol. 39 Issue 6, p41 

    Discusses the advantages and indications of several antifungal agents. Reasons that the increased incidence of fungal infections shows no sign of decline or leveling of; Alternatives to amphotericin B deoxycholate; Infections caused by fungi, eukaryotes that are more complex organisms than...

  • Surface Response Modeling to Examine the Combination of Amphotericin B Deoxycholate and 5-Fluorocytosine for Treatment of Invasive Candidiasis. Hope, William W.; Warn, Peter A.; Sharp, Andrew; Reed, Paul; Keevil, Brian; Louie, Arnold; Denning, David W.; Drusano, George L. // Journal of Infectious Diseases;8/15/2005, Vol. 192 Issue 4, p673 

    The strategy of combining antifungal drugs in a treatment regimen may improve the outcome of invasive candidiasis. Using a well-validated pharmaco dynamic murine model of invasive candidiasis, we defined the effect of the combination of amphotericin B deoxycholate (AmB) and 5-fluorocytosine...

  • SYNTHESIS AND BIOLOGICAL SCREENING OF SOME NEW 2, 5-DISUBSTITUTED 1, 3, 4-OXADIAZOLES. Hemavathi, S. N.; Vishu Kumar, B. K.; Rai, K. M. Lokanatha // International Journal of Pharmacy & Pharmaceutical Sciences;Jul2011 Supplement 4, Vol. 3, p110 

    Emergence of resistant bacterial and fungal strains towards existing antimicrobial agents is one of the major motives for research and development of new molecules to defend them. Substituted 1,3,4-oxadiazoles are of considerable pharmaceutical and material interest, which is documented by a...

  • Candiden Vaginal Tablet.  // Royal Society of Medicine: Medicines;2002, p133 

    This article provides information on Candiden Vaginal Tablet, a proprietary, non-prescription preparation of the antifungal drug clotrimazole. It can be used particularly to treat vaginal thrush. It is available as a vaginal tablet, and is not given to children, except on medical advice.

  • Combination Polyene-Caspofungin Treatment of Rhino-Orbital-Cerebral Mucormycosis. Reed, Caitlin; Bryant, Richard; Ibrahim, Ashraf S.; Edwards Jr., John; Filler, Scott G.; Goldberg, Robert; Spellberg, Brad // Clinical Infectious Diseases;8/1/2008, Vol. 47 Issue 3, p364 

    Background. It has been axiomatic that echinocandins (e.g., caspofungin) are ineffective against mucormycosis. However, on the basis of preclinical data, we recently began treating rhino-orbital-cerebral mucormycosis (ROCM) with combination polyene-caspofungin therapy. Methods. To determine the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics