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Empirical antifungal therapy in febrile neutropenic patients: current status

C C Kibbler1

  • 1Department of Medical Microbiology, Royal Free Hospital, London, U.K. kibbler@rfhsm.ac.uk

Current Topics in Medical Mycology
|March 21, 1998
PubMed

Insights

Empirical antifungal therapy is standard for hematology patients, with intravenous amphotericin B as the preferred choice. Reevaluation is needed due to improved diagnostics and new antifungal agents for neutropenic patients.

Area of Science:

  • Hematology
  • Oncology
  • Infectious Diseases

Background:

  • Empirical antifungal therapy is standard in hematology and oncology, with increasing use.
  • Intravenous amphotericin B is the preferred agent, though evidence of benefit is limited, particularly in patients without prior prophylaxis.
  • Despite diagnostic improvements, many neutropenic patients die from undiagnosed fungal infections.

Purpose of the Study:

  • To reevaluate standard empirical antifungal therapy in hematology and oncology.
  • To consider the changing immune status of neutropenic patients.
  • To incorporate new antifungal agents for prophylaxis and treatment.

Main Methods:

  • Review of current practices in empirical antifungal therapy.
  • Analysis of evidence for intravenous amphotericin B.
  • Consideration of diagnostic advancements and new antifungal agents.

Main Results:

  • Intravenous amphotericin B is the current drug of choice.
  • Limited evidence supports its benefit, especially without prior antifungal prophylaxis.
  • Prompt treatment initiation is crucial for effectiveness.

Conclusions:

  • Standard empirical antifungal therapy requires reevaluation.
  • Improved targeting of prophylaxis and empirical therapy is possible.
  • Changes in neutropenic patient immune status and new antifungal agents necessitate this reevaluation.

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