EFFICACY OF FLUCONAZOLE IN THE TREATMENT OF UPPER GASTROINTESTINAL CANDIDIASIS IN NEUTROPENIC PATIENTS WITH CANCER - FACTORS INFLUENCING THE OUTCOME

Fluconazole has proved to be effective in treating oropharyngeal and e sophageal candidiasis in immunocompromised patients. However, sufficie nt data are lacking regarding the efficacy of this agent in neutropeni c hosts. The aim of the present study was to determine the clinical an d mycological efficacy of fluconazole and to define the factor(s) affe cting the outcome of fluconazole therapy in severely neutropenic patie nts (peripheral neutrophil count, <500/mu L) with cancer who have orop haryngeal and/or esophageal candidiasis. One hundred eleven patients w ith 129 episodes of candidal infections were treated with intravenous and consequently oral fluconazole (200 mg/d and 100 mg/d, respectively ). Overall clinical cure and mycological eradication rates were 82% an d 56%, respectively. Persistent neutropenia (P <.01), infection with a non-albicans strain of Candida (P =.012), and administration of antif ungal therapy during the second or a later neutropenic episode (P <.00 2) were independently associated with a worse outcome. We conclude tha t fluconazole is effective in the treatment of upper gastrointestinal candidiasis in neutropenic patients with cancer. Effective treatment o f the underlying malignancy, with the resultant recovery from neutrope nia, and the determination of the species of infecting Candida isolate s are required for the prediction of the outcome of antifungal therapy .