amphotericin-b and Chemotherapy-Induced-Febrile-Neutropenia

Fungal infections are a major complication of neutropaenia following chemotherapy. Their early diagnosis is difficult, and empirical antifungal treatment is widely used, and uses of less toxic drugs that reduce breakthrough infection are required.. We conducted a multicentre, open-label, randomised, non-inferiority trial to compare the safety and efficacy of intravenous itraconazole (ivITCZ) and liposomal amphotericin B (LAmB) as empirical antifungal therapy in patients with haematological malignancies with neutropaenia and persistent fever.. Patients with haematological malignancies who developed fever refractory to broad-spectrum antibacterial agents under neutropaenia conditions were enrolled. Patients were randomised for treatment with LAmB (3.0 mg/kg/d) or ivITCZ (induction: 400 mg/d, maintenance: 200 mg/d).. Observed overall favourable response rates of 17/52 (32.7%) and 18/50 (36.0%) in the LAmB and ivITCZ groups, with a model-based estimate of a 4% difference (90% CI, -12% to 20%), did not fulfil the statistical non-inferiority criterion. In the LAmB group, there were two cases of breakthrough infection and five cases of probable invasive fungal disease, whereas in the itraconazole group, neither breakthrough infection nor probable invasive fungal disease occurred. Patients in the ivITCZ group had significantly fewer grade 3-4 hypokalaemia-related events than LAmB group patients (P < .01). The overall incidence of adverse events tended to be lower in the ivITCZ group (P = .07).. ivITCZ showed similar efficacy and safety as LAmB as empirical antifungal therapy in haematological malignancy patients with febrile neutropaenia, although the small sample size and various limitations prevented demonstration of its non-inferiority.

Topics: Administration, Intravenous; Adult; Aged; Amphotericin B; Antifungal Agents; Chemotherapy-Induced Febrile Neutropenia; Female; Hematologic Neoplasms; Humans; Itraconazole; Male; Middle Aged; Mycoses; Young Adult

We report the first case of liver abscess due to Sterigmatomyces halophilus. Because this pathogen grows poorly in culture medium without added salts, it was identified by sequencing analysis targeting the rRNA gene internal transcribed spacer (ITS) region. This method could be useful for pathogens that cannot be cultured using standard methods.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Basidiomycota; Biopsy; Bone Marrow Transplantation; Cefozopran; Cephalosporins; Chemotherapy-Induced Febrile Neutropenia; Child; Hematopoietic Stem Cell Transplantation; Humans; Liver; Liver Abscess; Male; Micafungin; Mycoses; Neoplasm Recurrence, Local; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

The Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) here presents its updated recommendations for the treatment of documented fungal infections. Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. In recent years, new antifungal agents have been licensed, and agents already approved have been studied in new indications. The choice of the most appropriate antifungal treatment depends on the fungal species suspected or identified, the patient's risk factors (e.g., length and depth of neutropenia), and the expected side effects. This guideline reviews the clinical studies that served as a basis for the following recommendations. All recommendations including the levels of evidence are summarized in tables to give the reader rapid access to the information.

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Invasive; Catheter-Related Infections; Chemotherapy-Induced Febrile Neutropenia; Clinical Trials as Topic; Combined Modality Therapy; Drug Monitoring; Drug Therapy, Combination; Echinocandins; Fungemia; Humans; Immunocompromised Host; Immunotherapy; Invasive Pulmonary Aspergillosis; Mycoses; Neoplasms; Salvage Therapy; Triazoles

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Candidiasis, Invasive; Chemotherapy-Induced Febrile Neutropenia; Cytarabine; Daunorubicin; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Hepatitis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Splenic Diseases; Tomography, X-Ray Computed

In the attempt to establish key therapy definitions and provide shared approaches to invasive fungal diseases in neutropenic patients, trials of empiric, preeemptive and targeted antifungal therapy (EAT, PAT and TAT) were reviewed, and a Consensus Development Conference Project was convened. The Expert-Panel concurred that all antifungal treatments, including EAT, should always follow an adequate diagnostic strategy and that the standard definition of PAT may be misleading: being PAT guided by the results of a diagnostic work-up, it should better be termed diagnostic-driven antifungal therapy (DDAT). The Expert-Panel agreed that radiological findings alone are insufficient for the choice of a TAT and that the identification of the etiologic pathogen is needed. The Consensus Agreement proceeded identifying which clinical and microbiological findings were sufficient to start a DDAT and which were not. Finally, an algorithm to rationalize the choice of antifungal drugs on the basis of clinical manifestations, antifungal prophylaxis, instrumental and laboratory findings was drawn up.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Chemotherapy-Induced Febrile Neutropenia; Clinical Trials as Topic; Drug Administration Schedule; Drug Resistance, Fungal; Drug Therapy, Combination; Febrile Neutropenia; Fungi; Hematologic Neoplasms; Humans; Immunocompromised Host; Multicenter Studies as Topic; Mycoses; Premedication; Prospective Studies; Randomized Controlled Trials as Topic; Transplantation Conditioning; Triazoles