Oropharyngeal Candida prophylaxis in pediatric bone marrow transplant patients

The effect of a multi-agent regimen on oropharyngeal candidiasis (OPC) prophylaxis in 16 consecutive pediatric bone marrow transplant patients was assessed. The multi-agent regimen consisted of: 1) debriding all mucous membrane surfaces within the oropharyngeal cavity with povidone-iodine 4 times a day, 2) swabbing all mucous membrane surfaces within the oropharyngeal cavity with nystatin 4 times a day, and 3) Ketoconazole given daily by mouth. Multi-agent regimen therapy was initiated on the day marrow ablative therapy began, and was terminated when the patient's absolute neutrophil count recovered to above 500/mm3. Baseline oropharyngeal fungal cultures indicated that 8 out of 16 (50%) of the patients were Candida carriers. Subsequent surveillance cultures indicated that 13 out of 16 (81.3%) of the patients had negative oropharyngeal fungal cultures during the entire period they were on the multi-agent regimen. The remaining three patients had negative oropharyngeal fungal cultures by the end of the experimental period. None of the patients developed Candida esophagitis or sepsis. The above regimen is an effective and non-toxic method to prevent oropharyngeal candidiasis in pediatric BMT patients.