Role of antifungal drugs as prophylaxis or as preemptive therapy in neutropenic patients

Séminaire de Pathologie Infectieuse - UCL - 25/01/01

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Table of Contents

CHANGING PATTERN OF CAUSATIVE ORGANISMS

FACTORS RELATED TO THE INCREASING INCIDENCE OF FUNGAL INFECTIONS

ASPERGILLOSIS

ASPERGILLOSIS AT AUTOPSY - RISK GROUPS Vogeser et al Eur J Clin Microbiol Infect Dis 1999;18; 42-45

GROWTH OF ASPERGILLUS

COLONIZATION WITH CANDIDA SPECIES

HOSPITAL ACQUIRED CANDIDEMIA Wenzel Clin Infect Dis 1995;20:1531-4

OCCURRENCE OF NOSOCOMIAL BLOODSTREAM INFECTIONS Edmond et al , Clin Infect Dis 1999

INCIDENCE AND DISTRIBUTION OF NOSOCOMIAL BLOODSTREAM INFECTIONS Edmond et al, Clin Infect Dis 1999

THERAPEUTIC STRATEGIES

PROPHYLAXIS WITH FLUCONAZOLE IN BONE MARROW TRANSPLANTATION GOODMAN et al. N.ENGL.J.MED 1992, 326: 845

FLUCONAZOLE 400 mg/day AS PROPHYLAXIS IN BONE MARROW TRANSPLANTATION SLAVIN et al. J. Infect. Dis. 1995;171:1545

FLUCONAZOLE versus PLACEBO AS PROPHYLAXIS IN NEUTROPENIA Rotstein et al. Clin Infect Dis 1999;28:331

PROPHYLAXIS WITH FLUCONAZOLE IN ACUTE LEUKEMIA WINSTON et al. Ann Intern Med 1993, 118: 495

FLUCONAZOLE 400 mg/day AS PROPHYLAXIS IN LIVER TRANSPLANT RECIPIENTS WINSTON et al. Ann.Intern.Med. 1999;131:729-37

PREVENTION OF ASPERGILLOSIS

IMPACT OF NON-ORAL AMPHOTERICIN B ON THE PREVENTION OF ASPERGILLUS INFECTIONS IN NEUTROPENIC PATIENTS

CHANGING INCIDENCE OF FUNGAL INFECTIONS IN BONE MARROW TRANSPLANTATION O'DONNELL ET AL J.CLIN. ONCOL. 1994

RANDOMIZED STUDY OF AMPHOTERICIN B INHALATION FOR THE PROPHYLAXIS OF FUNGAL INFECTIONS (Behre et al. Ann.Hematol. 1995 - Germany)

ITRACONAZOLE VERSUS FLUCONAZOLE AS PROPHYLAXIS DURING NEUTROPENIA MORGENSTERN et al, Brit J Haematol 1999

ITRACONAZOLE ORAL SOLUTION VERSUS PLACEBO AS PROPHYLAXIS IN HEMATOLOGIC MALIGNANCY Menichetti et al.. Clin Infect Dis 1999;28:250

ITRACONAZOLE ORAL SOLUTION versus AMPHO-B CAPSULES AS PROPHYLAXIS [HAROUSSEAU et al. Antimicrob Ag Chemother 2000; 44:1887-93]

DOUBLE-BLIND TRIAL ON ITRACONAZOLE AS PROPHYLAXIS IN NEUTROPENIA [NUCCI et al. Clin Infect Dis 2000; 30:300]

DOCUMENTED FUNGAL INFECTIONS ITRACONAZOLE versus PLACEBO

ALL RISK IS RELATIVE

GROUPS BENEFITTING FROM FLUCONAZOLE PROPHYLAXIS IN NEUTROPENIA Rotstein et al. Clin Infect Dis 1999;28:331

COLONIZATION-BASED FLUCONAZOLE PROPHYLAXIS DURING NEUTROPENIA Guiot et al, ICAAC 1996

AMBISOME versus FLUCONAZOLE plus ITRACONAZOLE as PROPHYLAXIS Mattiuzzi et al. ICAAC 2000, Toronto. Abstr J 716, p.363

DISTRIBUTION OF SPECIES CAUSING CANDIDEMIA IN DUTCH UNIVERSITY HOSPITALS VOSS ET AL. EUR J CLIN MICROBIOL INFECT DIS 1996

Empiric Therapy

AMPHOTERICIN-B FOR FEVER PERSISTING 4-7 DAYS

PERCEIVED NEED FOR PARENTERAL AMPHOTERICIN-B AFTER PROPHYLAXIS IN NEUTROPENIC PATIENTS

INTERRELATION OF ANTIFUNGAL STRATEGIES DURING GRANULOCYTOPENIA STATE OF THE ART??

AMBISOME® VERSUS AMPHOTERICIN-B AS EMPIRIC THERAPY FOR REFRACTORY FEVER WALSH et al, N Engl J Med 1999;340:764

AMPHOTERICIN-B VERSUS ITRACONAZOLE iv --> solution AS EMPIRIC THERAPY FOR REFRACTORY FEBRILE NEUTROPENIA Boogaerts: investigators meeting ITR-INT-62 Janssen 1998

EMPIRICAL VORICONAZOLE vs AMBISOME FOR PERSISTENTLY FEBRILE NEUTROPENICS II Walsh et al, ICAAC Toronto 2000. Abstr L1, Addendum p. 20-21

DEFERVESCENCE AFTER EMPIRIC INSTITUTION OF ANTIFUNGALS

AMPHOTERICIN-B VERSUS FLUCONAZOLE AS EMPIRIC THERAPY FOR REFRACTORY FEVER IN CANCER VISCOLI et al, EUR.J.CANCER 1996

EMPIRIC ANTIFUNGALS FOR REFRACTORY FEVER: DAY 3 versus DAY 6

DIAGNOSIS VERSUS EMPIRIC TREATMENT

WHAT DOES PRE-EMPTIVE MEAN?

IMPACT OF SYSTEMATIC CT-SCAN ON THE OUTCOME OF PULMONARY ASPERGILLOSIS CAILLOT ET AL. J CLIN ONCOL 1997

ASPERGILLUS ANTIGEN FOR EARLIER DETECTION OF INVASIVE INFECTION

PCR SCREENING FOR FUNGI IN HIGH RISK PATIENTS Hebart, Einsele et al. Brit J Haematol 2000; 111:635-40

TIME TO POSITIVE TESTS TO DETECT PULMONARY ASPERGILLOSIS Kami et al. Haematologica 2000; 85:745-52

START OF EMPIRIC ANTIFUNGALS

PRE-EMPTIVE ANTIFUNGALS: THE RATIONAL FUTURE?

GUIDELINES FOR THE TREATMENT OF CANDIDIASIS IDSA, Clin Infect Dis 2000; 30:662-78

COMPARISON OF EFFICACY IN PROVEN AND PRESUMED FUNGAL INFECTIONS

CANDIDA ISOLATES AND CANDIDEMIA IN BMT AFTER INTRODUCTION OF FLUCONAZOLE PROPHYLAXIS (Marr, Seidel, White, Bowden J Infect Dis 2000:309)

HIGH DOSE FLUCONAZOLE RESCUE FOR REFRACTORY CANDIDA INFECTIONS OUTCOME AS PER CANDIDA SPECIES

VORICONAZOLE FOR NON- ASPERGILLOSIS COMPANY FILE DATA

CASPOFUNGIN FOR OROPHARYNGEAL CANDIDIASIS Randomized Comparison of Response with Amphotericin B

EFFICACY IN PROVEN AND PROBABLE ASPERGILLUS INFECTIONS

PRIORITIES OF THE MEDICAL COMMUNITY

AMBISOME versus AMPHOTERICIN B in PROVEN AND PROBABLE ASPERGILLOSIS DEMARIE, LEENDERS et al, Brit J Haematol. 1998

PREDICTABLE AMPHOTERICIN B NEPHROTOXITY WINGARD et al. Clin. Infec.t Dis. 1999;29:1402-7

ITRACONAZOLE FOR ASPERGILLOSIS DENNING et al. Am J Med 1994

PROBABLE AND PROVEN ASPERGILLOSIS: FAILURES AND RESPONSES TO VORICONAZOLE 

VORICONAZOLE FOR PROVEN AND PROBABLE ASPERGILLOSIS - COMPANY FILE DATA

VORICONAZOLE FOR MOULD INFECTIONS RESPONSE BY SITE OF INFECTION

PRE-EMPTIVE ANTIFUNGAL APPROACH

Author: B. De Pauw

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