Document Detail

Progress in fighting systemic fungal infections in haematological neoplasia.
MedLine Citation:
PMID:  9458534     Owner:  NLM     Status:  MEDLINE    
Considering the limited data available, there is clearly a need for thorough, well-designed clinical research on the epidemiology, diagnosis, treatment and prevention of invasive fungal infection in patients who are treated for cancer. Our knowledge has increased, but the information obtained so far is patchy and not generally applicable, as it is influenced by local problems and circumstances. New diagnostic tools have become available, but they are still insufficient in many cases. Until the value of the presently available chemoprophylaxis has been established beyond doubt, the strategy should be one of wait-and-see for patients with a low or moderate risk of developing infection. In bone marrow transplant recipients fluconazole has shown favourable results in eliminating yeast infections, but in patients at high risk of mould infections early initiation of intravenous treatment with amphotericin B at a therapeutic dose remains the best approach. The question of the optimal time point to start empirical antifungal treatment remains and has even been extended by the dispute about what antifungal drugs should be used for this purpose. Amphotericin B is still the drug of choice for the treatment of disseminated fungal infection, but its lipid formulations seem to offer a safer, though far more expensive, alternative. Head-to-head comparisons between the different formulations are required before a final conclusion on their respective efficacies and toxicities can be drawn, and it is questionable whether a higher dose will produce better results. Fluconazole appears very useful against the majority of Candida infections, whereas itraconazole is effective against both yeast and moulds, providing that adequate resorption can be ensured. The results of the first clinical trial of voriconazole in pulmonary aspergillosis have proved very promising.
B E De Pauw; J F Meis
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer     Volume:  6     ISSN:  0941-4355     ISO Abbreviation:  Support Care Cancer     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-03-19     Completed Date:  1998-03-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9302957     Medline TA:  Support Care Cancer     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  31-8     Citation Subset:  IM    
Department of Haematology, University Hospital St. Radboud, Nijmegen, The Netherlands.
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MeSH Terms
Antifungal Agents / therapeutic use*
Aspergillosis / complications,  drug therapy*
Candidiasis / complications,  drug therapy*
Clinical Trials as Topic
Fungemia / complications,  diagnosis,  drug therapy*
Hematologic Neoplasms / complications*
Treatment Outcome
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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