PROBLEMS AND CONTROVERSIES IN THE MANAGEMENT OF HEMATOGENOUS CANDIDIASIS

Hematogenous candidiasis is associated with substantial mortality and morbidity. Amphotericin B has routinely been used to treat this infect ion. However, tolerance of therapy with amphotericin B is limited by t he drug's toxicity. The results of recently completed prospective rand omized clinical studies comparing amphotericin B with fluconazole for the treatment of hematogenous candididiasis suggest that fluconazole i s as effective as amphotericin B and that fluconazole is better tolera ted by patients. Nevertheless, several questions remain to be answered regarding the optimal choice of antifungal agent for both nonneutrope nic and neutropenic patients, the dosing schedule and duration of ther apy, the role of combination antifungal therapy, and the efficacy of t he lipid formulations of polyenes. Controversial issues with respect t o the role of central venous catheters in the pathogenesis of hematoge nous candidiasis, as well as the roles of cytokines and white blood ce ll transfusions in the treatment of neutropenic patients with hematoge nous candidiasis, also need to be addressed.