Itraconazole versus Fluconazole for Antifungal Prophylaxis
Authors: Drew J. Winston, Richard T. Maziarz, Pranatharthi H. Chandrasekar
Journal: Annals of Internal Medicine (2004)

Letters6 April 2004Itraconazole versus Fluconazole for Antifungal ProphylaxisDrew J. Winston, MD, Richard T. Maziarz, and Pranatharthi H. Chandrasekar, MDDrew J. Winston, MDFrom University of California, Los Angeles, Medical Center, Los Angeles, CA 90095; Oregon Health & Science University, Portland, OR 97232; and Harper University Hospital, Detroit, MI 48201.Search for more papers by this author, Richard T. MaziarzFrom University of California, Los Angeles, Medical Center, Los Angeles, CA 90095; Oregon Health & Science University, Portland, OR 97232; and Harper University Hospital, Detroit, MI 48201.Search for more papers by this author, and Pranatharthi H. Chandrasekar, MDFrom University of California, Los Angeles, Medical Center, Los Angeles, CA 90095; Oregon Health & Science University, Portland, OR 97232; and Harper University Hospital, Detroit, MI 48201.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-7-200404060-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We do not dispute the efficacy of fluconazole for prevention of Candida infections in transplant recipients (1, 2). However, the usefulness of fluconazole for antifungal prophylaxis in recipients of allogeneic hematopoietic stem-cell transplants has recently been compromised by the increasing incidence of Aspergillus and certain fluconazole-resistant Candida infections. Furthermore, while the Seattle study reported improved long-term survival in patients receiving prophylactic fluconazole after allogeneic hematopoietic stem-cell transplantation (3), these results were not seen in the study by Goodman and colleagues and in other trials of fluconazole prophylaxis (1, 2). It is also uncertain that the improved long-term survival ...References1. 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 Scholar2. Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1999;131:729-37. [PMID: 19999295] LinkGoogle Scholar3. 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 Scholar4. Van Burik J, Ratanatharathorn V, Lipton J, Miller C, Bunin N, Walsh T. Randomized, double-blind trial of micafungin versus fluconazole for prophylaxis of invasive fungal infections in patients undergoing hematopoietic stem cell transplant [Abstract]. Presented at 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, California, 27–30 September 2002. Abstract no. M-1238 Google Scholar5. Mossad SB, Avery RK, Bolwell BJ. Importance of antifungal prophylaxis in patients who received a nonmyeloablative allogeneic PBSC transplant [Letter]. Clin Infect Dis. 2003;936:1503-4. [PMID: 12766853] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, Los Angeles, Medical Center, Los Angeles, CA 90095; Oregon Health & Science University, Portland, OR 97232; and Harper University Hospital, Detroit, MI 48201. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoProphylactic Fluconazole in Liver Transplant Recipients Drew J. Winston , Anita Pakrasi , and Ronald W. Busuttil 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 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 Meinolf Karthaus , Oliver A. Cornely , and Andrew J. Ullmann Itraconazole versus Fluconazole for Antifungal Prophylaxis John H. Powers and Karen M. Higgins Itraconazole versus Fluconazole for Antifungal Prophylaxis Sherif B. Mossad Metrics 6 April 2004Volume 140, Issue 7Page: 581-582KeywordsAmphotericinAntifungalsAspergillosisCandidaInfectious disease immunologyNeutropeniaProphylaxisTasteToxicityTransplantation ePublished: 6 April 2004 Issue Published: 6 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...