Itraconazole versus Fluconazole for Antifungal Prophylaxis
Authors: Meinolf Karthaus, Oliver A. Cornely, Andrew J. Ullmann
Journal: Annals of Internal Medicine (2004)

Letters6 April 2004Itraconazole versus Fluconazole for Antifungal ProphylaxisMeinolf Karthaus, MD, Oliver A. Cornely, MD, and Andrew J. Ullmann, MDMeinolf Karthaus, MDFrom Ev. Johannes-Krankenhaus, D-33611 Bielefeld, Germany; Universität zu Köln, D-50924 Köln, Germany; and Universitätsklinik Mainz, D-55101 Mainz, Germany.Search for more papers by this author, Oliver A. Cornely, MDFrom Ev. Johannes-Krankenhaus, D-33611 Bielefeld, Germany; Universität zu Köln, D-50924 Köln, Germany; and Universitätsklinik Mainz, D-55101 Mainz, Germany.Search for more papers by this author, and Andrew J. Ullmann, MDFrom Ev. Johannes-Krankenhaus, D-33611 Bielefeld, Germany; Universität zu Köln, D-50924 Köln, Germany; and Universitätsklinik Mainz, D-55101 Mainz, Germany.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-7-200404060-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Winston and colleagues (1) reported that itraconazole was more effective than fluconazole for antifungal prophylaxis in recipients of allogeneic hematopoietic stem-cell transplants. We do not agree completely with their conclusion. Two well-designed, double-blind clinical trials showed that fluconazole is beneficial in this population (2, 3). The efficacy of fluconazole was further emphasized by an evidence-based analysis of the literature that involved more than 9000 patients (4). Fluconazole lacks efficacy against Candida krusei and C. glabrata and particularly against Aspergillus species, which pose a major threat late in the post-transplantation period.Over the years, the rate of invasive ...References1. Winston DJ, Maziarz RT, Chandrasekar PH, Lazarus HM, Goldman M, Blumer JL, et al . Intravenous and oral itraconazole versus intravenous and oral fluconazole for long-term antifungal prophylaxis in allogeneic hematopoietic stem-cell transplant recipients. A multicenter, randomized trial. Ann Intern Med. 2003;138:705-13. [PMID: 12729424] LinkGoogle Scholar2. Slavin MA, Osborne B, Adams R, Levenstein MJ, Schoch HG, Feldman AR, et al . Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation—a prospective, randomized, double-blind study. J Infect Dis. 1995;171:1545-52. [PMID: 7769290] CrossrefMedlineGoogle Scholar3. Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, et al . A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med. 1992;326:845-51. [PMID: 1542320] CrossrefMedlineGoogle Scholar4. Cornely OA, Ullmann AJ, Karthaus M. Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies. Blood. 2003;101:3365-72. [PMID: 12393455] CrossrefMedlineGoogle Scholar5. Marr KA, Carter RA, Boeckh M, Martin P, Corey L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood. 2002;100:4358-66. [PMID: 12393425] CrossrefMedlineGoogle Scholar6. Marr KA, Seidel K, Slavin MA, Bowden RA, Schoch HG, Flowers ME, et al . Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood. 2000;96:2055-61. [PMID: 10979947] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Meinolf Karthaus, MD; Oliver A. Cornely, MD; Andrew J. Ullmann, MDAffiliations: From Ev. Johannes-Krankenhaus, D-33611 Bielefeld, Germany; Universität zu Köln, D-50924 Köln, Germany; and Universitätsklinik Mainz, D-55101 Mainz, Germany. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntravenous and Oral Itraconazole versus Intravenous and Oral Fluconazole for Long-Term Antifungal Prophylaxis in Allogeneic Hematopoietic Stem-Cell Transplant Recipients: A Multicenter, Randomized Trial Drew J. Winston , Richard T. Maziarz , Pranatharthi H. Chandrasekar , Hillard M. Lazarus , Mitchell Goldman , Jeffrey L. Blumer , Gerhard J. Leitz , and Mary C. Territo Itraconazole versus Fluconazole for Antifungal Prophylaxis John H. Powers and Karen M. Higgins Itraconazole versus Fluconazole for Antifungal Prophylaxis Sherif B. Mossad Itraconazole versus Fluconazole for Antifungal Prophylaxis Drew J. Winston , Richard T. Maziarz , and Pranatharthi H. Chandrasekar Metrics Cited byRecent developments in the management of invasive fungal infections in patients with hematological malignancies 6 April 2004Volume 140, Issue 7 Page: 579-580 Keywords Antifungals Clinical trials Death rates Infectious diseases Medical risk factors Mortality Prophylaxis Safety Transplantation Yeast infections ePublished: 6 April 2004 Issue Published: 6 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...