[Preventive drug therapy of mycoses in surgery]

In surgery there exist several groups of patients with significant risk of deep-seated mycoses, e.g., those undergoing cardiac surgery, renal transplantation, intravenous alimentation or suffering from grave burn injury. "Blind prophylaxis" which would be applied indiscriminately to all patients of the respective groups cannot be recommended with the presently available systemic (parenteral or orally absorbed) antimycotic drugs for reasons such as toxicity or risk of resistance. Less objections exist against the oral, not absorbed polyene antibiotics; however, prophylaxis with these drugs only covers candidiasis affecting, or originating from, the digestive tract and lacks statistical proof of efficacy. As an alternative to "blind prophylaxis", selective prophylaxis" is proposed which is consistent with close supervision of the patients and start of antimycotic treatment as soon as there are signs of a probable fungal infection. This is, more correctly, a sort of "early therapy".