LETTER
Fluconazole Prophylaxis in Patients with Leukemia
Hidecki Akiyama;
Hisashi Sakamaki; and
Yasusuke Onozawa
1 November 1993 | Volume 119 Issue 9 | Pages 951-952
TO THE EDITOR:
Winston and coworkers [1] describe a prophylactic effect of fluconazole against colonization and superficial infections caused by Candida species other than Candida krusei in patients with acute leukemia. They observed an increased incidence of colonization by C. krusei but not by Torulopsis glabrata in the fluconazole group. We use fluconazole (200 mg/d) from the day of initiation of chemotherapy until the day when the neutrophil count exceeds 0.5 x 109/L in patients with chemotherapy-induced neutropenia. Between January 1991 and October 1992, we obtained surveillance cultures of the stool in 31 patients with acute leukemia who were receiving fluconazole after chemotherapy. We found colonization by T. glabrata in 12 patients, by C. krusei in 1 patient, and by C. albicans in 2 patients. A 48-year-old man with acute myelogenous leukemia developed T. glabrata septicemia.
Surveillance cultures in 28 patients receiving amphotericin B syrup, 800 mg three times a day, during the same treatment period showed colonization by T. glabrata, C. krusei, and C. albicans in 1, 0, and 7 patients, respectively. Even though the data on the control group are not available, all patients were negative for fungus initially, suggesting the relative ineffectiveness of fluconazole against T. glabrata.
This high incidence of colonization by T. glabrata might be attributable to the use of lower-dose fluconazole or geographic differences. Because of reports of T. glabrata septicemia in patients receiving fluconazole [2-4], it is important to consider the risk for colonization and invasive infection by T. glabrata during fluconazole prophylaxis.
1. Winston DJ, Chandrasekar PH, Lazarus HM, Goodman JL, Silber JL, Horowitz H, et al. Fluconazole prophylaxis of fungal infection in patients with acute leukemia: results of a randomized placebo-controlled, double-blind, multicenter trial. Ann Intern Med. 1993; 118: 495-503.
2. Stark A, Dale B, Toolis F. Fluconazole chemoprophylaxis in neutropenic patients (Letter). Br J Haematol. 1993; 83:348.
3. Meunier F, Aoun M, Janssens M, Dekoster C, Paesmans M. Chemoprophylaxis of fungal infections in granulocytopenic patients using fluconazole vs oral amphotericin B. Drug Invest. 1991; 3:258-65.
4. Rozenberg-Arska M, Dekker AW, Branger J, Verhoef J. A randomized study to compare oral fluconazole to amphotericin B in the prevention of fungal infections in patients with acute leukemia. J Antimicrob Chemother. 1991; 27:369-76.
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