HEMATOGENOUS CANDIDIASIS - A REVIEW OF THERAPEUTIC STUDIES OF FLUCONAZOLE AND AMPHOTERICIN-B AND RECOMMENDATIONS FOR MANAGEMENT

Background. Hematogenous candidiasis is increasing in incidence and is associated with significant morbidity and mortality. Objectives. To e valuate the role of amphotericin B and fluconazole in the treatment of hematogenous candidiasis and to give recommendations for the manageme nt of this infection. Methods. A MEDLINE search of relevant publicatio ns was performed. Studies identified by the search which evaluate the role of fluconazole or amphotericin B as therapeutic regimens for hema togenous candidiasis were reviewed. Results. The results of two prospe ctive randomized trials comparing fluconazole with amphotericin B sugg est that fluconazole is as effective as amphotericin B and less toxic. While these data confirm the findings of several small series and ret rospective studies that suggested a good activity of fluconazole in th e treatment of hematogenous candidiasis, a definitive conclusion as to the equivalent efficacy of the two drugs across all populations canno t be substantiated. Conclusions. Given the acceptable efficacy of fluc onazole and its superior safety profile, the use of this drug is recom mended for the treatment of hematogenous candidiasis caused by flucona zole-susceptible species. Several important issues remain to be answer ed, such as the drug of choice for patients with neutropenia and those infected with the various non-albicans Candida species, the dosage-sc hedule and duration of antifungal therapy in low- and high-risk patien ts, and the role of the vascular catheters.