Fluconazole versus amphotericin B for the prevention of fungal infection in neutropenic patients with hematologic malignancy

Effective prophylaxis against fungal infection is important in neutropenic patients with hematologic malignancies, but the best method remains unclear : We investigated the effectiveness of fungal prophy laxis with amphoterici n B or fluconazole. We reviewed the data on fungal isolates, plasma (1-->3) - beta-D glucan (beta-D glucan) levels, febrile periods (the number of days with an axillary temperature >38 degrees C), and the duration of an axilla ry temperature >38 degrees C when the neutrophil count was <500/mu l. Of th e 124 patients studied, 57 had acute myelogenous leukemia, 19 had acute lym phoblastic leukemia, 18 had non-Hodgkin's lymphoma, six had chronic myeloid leukemia, three had adult T-cell leukemia, and five had chronic lymphocyti c leukemia. There were no significant differences in clinical characteristi cs between the 70 patients treated with amphotericin B and the 54 patients given fluconazole. There was a significant decrease of fungal isolates (chi (2)-test, p <0.001), the plasma beta-D glucan level (Wilcoxon test, p =0.00 01), and the febrile period (t-test, p <0.05) in the patients given flucona zole compared with those given amphotericin B. In neutropenic patients with hematologic malignancies, prophylaxis with fluconazole significantly decre ased fungal isolation and other indicators of fungal infection when compare d with amphotericin B. Fluconazole may therefore be more effective for fung al prophylaxis in these patients.