Antifungal prophylaxis with low doses fluconazole in patients with hematological malignancies

Abstract

Introduction: The incidence of mycotic infections in immunocompromised patients has reached a 20-fold rise for the last two decades.

Aim: The goal of the study was to evaluate fluconazole efficacy as antifungal prophylaxis in patients with hematological malignancies.

Material and methods: Sixty nine patients with hematological malignancies and neutrophil count less than 1.0 x 10(9)/L received fluconazole orally at a dose of 150 mg every other day. Fluconazole was discontinued when a neutrophil count above 1.5 x 10(9)/L was maintained. Duration of neutropenic periods, afebrile cycles, and incidence of mycotic infections were assessed. The same variables were observed in a control group of 41 patients who did not receive antifungal prophylactic therapy.

Results: Both groups were similar in the mean duration of neutropenic period but the afebrile cycles in the patients receiving antifungal prophylaxis were longer by 5 days compared to these in the patients without prophylaxis. The mycotic infections had lower incidence in the patients on antifungal prophylaxis and the difference was statistically significant (p < 0.01). The superficial mycotic infections composed the majority of the clinically and/or microbiologically verified infections. These were presented by oropharyngeal infection (61%), esophageal (22%), and single cases of skin, genital or rectal infections. Candida albicans was isolated in 85% of the cases. The adverse reactions of fluconazole therapy were mild, transient, and easily manageable. No signs of liver and renal dysfunction were observed.

Conclusion: Lower dose of fluconazole, 150 mg every other day p.o., has the same antifungal effect as a dose of 200 mg/day p.o. in neutropenic patients with hematological malignancies which lowers the cost of treatment.