Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage.

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Abstract

Patients with hematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Primary or secondary antifungal prophylaxis is recommended for patients with hematological malignancies to reduce the risk of invasive fungal infection (IFI). This study retrospectively evaluated the efficacy and potential harm of administration of primary and secondary antifungal prophylaxis to patients with hematological malignancies at one hospital.

Most cited references 32

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Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

Alison Freifeld, Eric Bow, Kent A. Sepkowitz … (2011)

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

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2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.

Walter Hughes, Donald Armstrong, Gerald Bodey … (2002)

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Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes.

Saskia Bolay, Thierry Calandra, Jacques Bille … (2008)

Voriconazole is the therapy of choice for aspergillosis and a new treatment option for candidiasis. Liver disease, age, genetic polymorphism of the cytochrome CYP2C19, and comedications influence voriconazole metabolism. Large variations in voriconazole pharmacokinetics may be associated with decreased efficacy or with toxicity. This study was conducted to assess the utility of measuring voriconazole blood levels with individualized dose adjustments. A total of 181 measurements with high-pressure liquid chromatography were performed during 2388 treatment days in 52 patients. A large variability in voriconazole trough blood levels was observed, ranging from 5.5 mg/L (a level possibly associated with toxicity) in 31% of cases. Lack of response to therapy was more frequent in patients with voriconazole levels 1 mg/L (15 [12%] of 39 patients; P=.02). Blood levels >1 mg/L were reached after increasing the voriconazole dosage, with complete resolution of infection in all 6 cases. Among 16 patients with voriconazole trough blood levels >5.5 mg/L, 5 patients (31%) presented with an encephalopathy, including 4 patients who were treated intravenously with a median voriconazole dosage of 8 mg/kg per day, whereas none of the patients with levels

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Author and article information

Journal

Journal ID (iso-abbrev): Ther Clin Risk Manag

Title: Therapeutics and clinical risk management

Publisher: Informa UK Limited

ISSN: 1176-6336

ISSN (Print): 1176-6336

Publication date (Electronic): 2014

Volume: 10

Affiliations

[1 ] Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

[2 ] Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey.

Article

Publisher Item ID: tcrm-10-305

DOI: 10.2147/TCRM.S59683

PMC ID: 4011927

PubMed ID: 24855365

SO-VID: 931a3115-3784-4f1e-956f-febc8784cdc4

History

Keywords: azole resistance,febrile neutropenia,hematological malignancy,invasive fungal infection,primary antifungal prophylaxis,secondary antifungal prophylaxis

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Keywords: azole resistance, febrile neutropenia, hematological malignancy, invasive fungal infection, primary antifungal prophylaxis, secondary antifungal prophylaxis

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage.

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Abstract

Most cited references 32

Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.

Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes.

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