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Antifungal prophylaxis with azole derivatives
E Castagnola1, M Machetti, B Bucci
1Infectious Diseases Unit and Department of Haematology and Oncology, G.Gaslini Children's Hospital, Genoa, Italy.
Summary
Antifungal prophylaxis with fluconazole and itraconazole can reduce fungal infections in hospitalized patients. However, caution is advised due to potential side effects and resistance development, especially in high-risk individuals.
Area of Science:
- Infectious Diseases
- Mycology
- Hospital Medicine
Background:
- Fungal infections are a growing cause of severe illness and death in hospitals.
- Antifungal chemoprophylaxis is increasingly considered to combat these infections.
- High mortality rates associated with fungal infections necessitate preventative strategies.
Purpose of the Study:
- To evaluate the efficacy and risks of antifungal prophylaxis in hospitalized patients.
- To assess the impact of fluconazole and itraconazole on Candida colonization and infection.
- To determine the role of prophylaxis in reducing fungus-related mortality.
Main Methods:
- Systematic review of existing evidence on antifungal prophylaxis.
- Comparison of fluconazole and itraconazole versus placebo or nonabsorbable antifungals.
- Analysis of data on prevention of invasive fungal infections, including aspergillosis.
Main Results:
- Fluconazole and itraconazole reduce Candida colonization and infection compared to placebo.
- Prophylaxis may decrease fungus-related mortality but has minimal effect on overall mortality.
- Itraconazole is effective against invasive aspergillosis but associated with more side effects.
Conclusions:
- Antifungal prophylaxis with triazoles should be reserved for high-risk patients.
- Risks include selection of resistant strains and altered infection patterns.
- High-risk groups include bone marrow transplant recipients, leukemia patients, VLBW infants, and ICU patients.