EFFECT OF FLUCONAZOLE PROPHYLAXIS ON FEVER AND USE OF AMPHOTERICIN IN NEUTROPENIC CANCER-PATIENTS

We studied the impact of fluconazole prophylaxis (400 mg/day) on clinical features including fever and use of amphotericin in a randomized, double-blind, placebo-controlled (1:1 randomization) study among patients undergoing chemotherapy for leukemia and those undergoing bone marrow transplantation. Fluconazole or placebo was given throughout the period of neutropenia. Amphotericin was administered to 5 of 23 (22%) fluconazole recipients and 14 of 23 (58%) placebo recipients (p < 0.01). Median duration of amphotericin used in fluconazole and placebo groups was 9 days (mean 10.8) and 13 days (mean 14) respectively. Patients who received fluconazole had significantly shorter duration of fever prior to treatment with amphotericin (days, median 5 vs. 9, p < 0.05). Superficial fungal infections were noted in 8 (34%) fluconazole recipients and 19 (79%) placebo recipients (p = 0.002). Fluconazole was well tolerated. Prophylaxis with fluconazole resulted in a significant reduction in the empiric use of amphotericin, duration of fever and incidence of superficial fungal infections.