Abstract
Fungal infections in neutropenic cancer patients have increased in frequency and constitute an important cause of morbidity and mortality. Empiric antifungal therapy is often administered to those patients who have failed to respond to antibacterial antibiotics. We conducted a prospective, randomized trial of amphotericin B and ketoconazole for 172 neutropenic cancer patients with presumed or proven fungal infections. Overall, amphotericin B and ketoconazole were equally effective. Amphotericin B may have been more effective than ketoconazole for the treatment of pneumonia. Also, five of eight Candida tropicalis infections treated with amphotericin B responded, whereas all eight infections treated with ketoconazole failed to respond (P = 0.03). Response rates for localized fungal infections were similar with both drugs. Ketoconazole should not be used as empiric antifungal therapy at institutions where there is a high frequency of infections caused by Aspergillus spp. or C. tropicalis because this agent lacks activity in vitro against these species.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bodey G. P. Fungal infections complicating acute leukemia. J Chronic Dis. 1966 Jun;19(6):667–687. doi: 10.1016/0021-9681(66)90066-x. [DOI] [PubMed] [Google Scholar]
- De Jongh C. A., Wade J. C., Schimpff S. C., Newman K. A., Finley R. S., Salvatore P. C., Moody M. R., Standiford H. C., Fortner C. L., Wiernik P. H. Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: a comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. Am J Med. 1982 Jul;73(1):89–96. doi: 10.1016/0002-9343(82)90935-4. [DOI] [PubMed] [Google Scholar]
- Fainstein V., Bodey G. P., Bolivar R., Elting L., McCredie K. B., Keating M. J. Moxalactam plus ticarcillin or tobramycin for treatment of febrile episodes in neutropenic cancer patients. Arch Intern Med. 1984 Sep;144(9):1766–1770. [PubMed] [Google Scholar]
- Gold J. W. Opportunistic fungal infections in patients with neoplastic disease. Am J Med. 1984 Mar;76(3):458–463. doi: 10.1016/0002-9343(84)90665-x. [DOI] [PubMed] [Google Scholar]
- Hart P. D., Russell E., Jr, Remington J. S. The compromised host and infection. II. Deep fungal infection. J Infect Dis. 1969 Aug;120(2):169–191. doi: 10.1093/infdis/120.2.169. [DOI] [PubMed] [Google Scholar]
- Maksymiuk A. W., Thongprasert S., Hopfer R., Luna M., Fainstein V., Bodey G. P. Systemic candidiasis in cancer patients. Am J Med. 1984 Oct 30;77(4D):20–27. [PubMed] [Google Scholar]
- Meunier-Carpentier F. Symposium on infectious complications of neoplastic disease (Part II). Chemoprophylaxis of fungal infections. Am J Med. 1984 Apr;76(4):652–656. doi: 10.1016/0002-9343(84)90290-0. [DOI] [PubMed] [Google Scholar]
- Moody M. R., Young V. M., Morris M. J., Schimpff S. C. In vitro activities of miconazole, miconazole nitrate, and ketoconazole alone and combined with rifampin against Candida spp. and Torulopsis glabrata recovered from cancer patients. Antimicrob Agents Chemother. 1980 May;17(5):871–875. doi: 10.1128/aac.17.5.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Myerowitz R. L., Pazin G. J., Allen C. M. Disseminated candidiasis. Changes in incidence, underlying diseases, and pathology. Am J Clin Pathol. 1977 Jul;68(1):29–38. doi: 10.1093/ajcp/68.1.29. [DOI] [PubMed] [Google Scholar]
- Pizzo P. A., Robichaud K. J., Gill F. A., Witebsky F. G. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med. 1982 Jan;72(1):101–111. doi: 10.1016/0002-9343(82)90594-0. [DOI] [PubMed] [Google Scholar]
- Rose H. D. Venous catheter-associated candidemia. Am J Med Sci. 1978 May-Jun;275(3):265–269. doi: 10.1097/00000441-197805000-00004. [DOI] [PubMed] [Google Scholar]
- Wingard J. R., Merz W. G., Saral R. Candida tropicalis: a major pathogen in immunocompromised patients. Ann Intern Med. 1979 Oct;91(4):539–543. doi: 10.7326/0003-4819-91-4-539. [DOI] [PubMed] [Google Scholar]
- Winston D. J., Ho W. G., Young L. S., Hewitt W. L., Gale R. P. Piperacillin plus amikacin therapy v carbenicillin plus amikacin therapy in febrile, granulocytopenic patients. Arch Intern Med. 1982 Sep;142(9):1663–1667. [PubMed] [Google Scholar]