Antifungal prophylaxis with itraconazole oral solution in neutropenic patients

The role of itraconazole in anti-fungal prophylaxis has been limited by the low bioavailability of the capsule formulation but the bioavailability of the oral solution is much improved. Three multi-centre studies using itraco nazole solution (5 mg/kg/day) have recently been completed. The UK trial co mpared itraconazole solution with fluconazole suspension (100 mg/day). No i nvasive aspergillosis occurred in the itraconazole arm and there were more fungal deaths due to proven/suspected infection in the fluconazole group th an in the itraconazole group (0 versus 7, p = 0.024). An Italian study comp ared itraconazole solution with placebo. Proven, suspected and superficial fungal infections were fewer in the itraconazole arm compared with placebo, with significant differences in proven and suspected systemic fungal infec tions (itraconazole 24 % versus placebo 33 %, p = 0.035). The third study c ompared itraconazole with amphotericin B capsules (2 g/day). There were mor e invasive fungal infections,Aspergillus infections and fungal deaths in th e amphotericin B arm than with itraconazole but none of these differences w ere statistically significant. Azole prophylaxis in neutropenic patients may reduce the incidence of Candi da infections, empirical amphotericin B usage, and the incidence of proven fungal infections. Itraconazole may be more effective than fluconazole in p reventing invasive aspergillosis. All of these effects are more pronounced in high risk patients.