Prophylaxis of oropharyngeal candidiasis with fluconazole

A total of 112 cancer patients who could ultimately be evaluated were randomly assigned in a double-blind study to receive either fluconazole or placebo as antifungal prophylaxis during hospitalization. Thrush, defined by appropriate lesions in the oropharynx and confirmed by scrapings and cultures positive for Candida species, occurred in 2% of the 58 patients given fluconazole and in 28% of the 54 patients given placebo (P = .0003). Candida species were cultured from initial throat specimens from 29 patients given fluconazole and from 26 patients given placebo. Oropharyngeal candidiasis was detected subsequently in 3% of the former patients and 54% of the latter patients (P = .0001). Adverse reactions that were probably due to or aggravated by fluconazole occurred in only four patients and consisted of transient liver function abnormalities in three instances and nausea and vomiting in one. Oral fluconazole is an effective agent for prophylaxis of oropharyngeal candidiasis in susceptible cancer patients.