ANTIFUNGAL TREATMENT IN PATIENTS WITH CANCER

Invasive fungal infections are one of the leading causes of morbidity and mortality in cancer patients. Amphotericin B deoxycholate is still considered the gold standard of antifungal therapy, although the new triazoles (itraconazole and, especially, fluconazole) have shown to be able to replace amphotericin B for some therapeutic indications. The new lipid formulations of amphotericin B have disclosed new therapeuti c perspectives, especially in patients with severe renal failure and d ocumented infections. At this time, indications, contraindications and limitation of the various drugs in the antifungal armamentarium are s till partially unclear. Antifungal prophylaxis with fluconazole may be indicated in high-risk patients, although the duration of such prophy laxis should be limited as much as possible, in order to prevent selec tion of resistant strains and acquired resistance. Empirical antifunga l therapy is used extremely widely (maybe, too widely) in many cancer centres, despite being based on limited clinical data. For this indica tion, fluconazole may also be effective in patients not receiving fluc onazole prophylaxis, in whom Aspergillus infection is unlikely.