PREVENTION OF ORAL CANDIDIASIS AND SYSTEMIC FUNGAL INFECTION IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES

Reliable data are not available on the efficacy of oral application of amphotericin B to prevent oral candidiasis and invasive Candida infec tion in patients with hematologic malignancies. Our experience with pa tients with poor compliance and low mucosal barriers reveal that Candi da is able to colonize the mucosa abundantly and to cause subsequent l ocal and invasive infection. An analysis of a number of recent studies on the efficacy of fluconazole delivers data on the incidence of inva sive Candida infection in patients without any antifungal prophylaxis (placebo) and patients given polyenes (amphotericin B or nystatin). Th ese data support our conclusion that amphotericin B should be used as first-line antifungal prophylaxis, which is supplemented with fluconaz ole in patients with a high degree of Candida colonization due to low mucosal defense and limited compliance. This cost-effective policy res ults in an incidence of invasive candidiasis of less than 1% and a res tricted use of empirical antifungal therapy.