The combination of oral amphotericin B with azoles prevents the emergence of resistant Candida species in neutropenic patients

Citation
Pj. Paterson et al., The combination of oral amphotericin B with azoles prevents the emergence of resistant Candida species in neutropenic patients, BR J HAEM, 112(1), 2001, pp. 175-180
Citations number
28
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
BRITISH JOURNAL OF HAEMATOLOGY
ISSN journal
00071048 → ACNP
Volume
112
Issue
1
Year of publication
2001
Pages
175 - 180
Database
ISI
SICI code
0007-1048(200101)112:1<175:TCOOAB>2.0.ZU;2-7
Abstract
The role of antifungal prophylaxis remains controversial and concerns exist that the use of azoles may potentiate the emergence of resistant Candida s pecies. We used a strategy of combining the latest azole/triazole with oral amphotericin B to reduce this risk. We analysed data on Candida colonizati on and candidaemia in neutropenic patients from four prophylaxis periods (1 985/6: ketoconazole and amphotericin B suspension; 1991/2 & 1997: fluconazo le and amphotericin B suspension; 1998/9: itraconazole) to look for evidenc e of the emergence of potentially resistant species. Overall, the percentag e of patients colonized with Candida fell significantly (69.3%, 57.5%, 43.2 % and 46%, respectively, P < 0.001) due to a decrease in colonization with C. albicans (49%, 23.1%, 22.2% and 25.2%, respectively, P < 0.001). However , in 1998/9, increased colonization, particularly with C. glabrata in the l ower gastrointestinal tract, was noted to coincide with the omission of ora l amphotericin B. Despite an increasing population of 'high risk' patients, the incidence of candidaemia has not changed significantly (2%, 1.4%, 1.2% and 2% respectively). However, species causing candidaemia have changed, w ith resistant organisms now predominating. Our findings support the use of azole prophylaxis although, in view of the trends noted when itraconazole w as used alone, we would recommend the additional use of oral amphotericin B .