MANAGEMENT OF INVASIVE CANDIDAL INFECTIONS - RESULTS OF A PROSPECTIVE, RANDOMIZED, MULTICENTER STUDY OF FLUCONAZOLE VERSUS AMPHOTERICIN-B AND REVIEW OF THE LITERATURE

We conducted a prospective, randomized, multicenter study comparing fl uconazole and amphotericin B in the treatment of candidal infections. One hundred and sixty-four patients (60 of whom were neutropenic) with documented or presumed invasive candidiasis were assigned to treatmen t with either fluconazole (400 mg daily) or amphotericin B (25-50 mg d aily; 0.67 mg/kg daily for neutropenic patients), Clinical response an d survival rates were assessed at 48 hours, after 5 days, and at the e nd of therapy. Overall response rates to fluconazole and amphotericin B were similar (66% and 64%, respectively). There were no differences in response as related to site of infection, pathogen, time to deferve scence, relapse, or survival rates between the groups. Adverse effects were more frequent with amphotericin B (35%) than with fluconazole (5 %; P < .0001), The results of this study confirm that fluconazole is a s effective as but better tolerated than amphotericin B in the treatme nt of candidal infections.