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Antifungal prophylaxis to prevent invasive mycoses among bone marrow transplantation recipients
P O Gubbins1, J L Bowman, S R Penzak
1Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Abstract:
We reviewed the effect of systemic, intranasal, and lipid formulations of amphotericin B, fluconazole, itraconazole for antifungal prophylaxis. Specifically we reviewed the effect of antifungal prophylaxis on the development of fungal colonization, frequency of superficial and invasive mycosis, and overall mortality and that due to invasive mycoses in bone marrow transplantation recipients. A MEDLINE search was conducted to identify literature describing the risk factors, epidemiology, and chemoprophylaxis of invasive mycosis in these patients. Preliminary data published as abstracts at national infectious diseases and hematology conferences within the last 5 years were included. Antifungal prophylaxis reduces fungal colonization and superficial infection. The ability of antifungal prophylaxis to prevent systemic infection or reduce the need for empiric amphotericin B depends on specific variables. Ultimately, antifungal prophylaxis has no affect on overall mortality, and very little impact on mortality attributed to fungi.
Insights
Antifungal prophylaxis, including agents like fluconazole, reduces fungal colonization and superficial infections in bone marrow transplant patients. However, it does not significantly impact overall mortality or deaths from invasive fungal infections.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Bone marrow transplantation (BMT) recipients are highly susceptible to invasive fungal infections.
- Fungal infections pose a significant threat to patient outcomes post-BMT.
- Antifungal prophylaxis is a strategy to mitigate these risks.
Purpose of the Study:
- To evaluate the impact of antifungal prophylaxis on fungal colonization, mycosis development, and mortality in BMT recipients.
- To assess the efficacy of various antifungal agents and formulations (amphotericin B, fluconazole, itraconazole) for prophylaxis.
- To identify factors influencing the effectiveness of antifungal prophylaxis.
Main Methods:
- Systematic review of literature using MEDLINE database.
- Inclusion of preliminary data from conference abstracts within the last 5 years.
- Focus on risk factors, epidemiology, and chemoprophylaxis of invasive mycosis in BMT patients.
Main Results:
- Antifungal prophylaxis effectively reduces fungal colonization and superficial mycoses.
- Prevention of systemic fungal infections and need for empiric amphotericin B is variable.
- No significant reduction in overall mortality was observed.
Conclusions:
- Antifungal prophylaxis is beneficial in reducing superficial fungal infections in BMT recipients.
- The impact on invasive mycosis and overall mortality is limited.
- Further research may be needed to optimize prophylactic strategies for BMT patients.