Comparative Cost-effectiveness Of Posaconazoleversus Fluconazole Or Itraconazole Prophylaxisrnin Patients With Prolonged Neutropenia

摘要

Invasive fungal infections cause significant morbidity and mortality in patients with hematologic malignancies and prolonged (i.e., longer than 7-10 days) treatment-induced neutropenia. Since the 1970s, neutropenic patients with fever persisting for longer than 5 days, despite treatment for broad-spectrum antibiotics, have been treated empirically with antifungal agents; typically, such patients have been treated with amphotericin B. Recently, the echinocandin caspo-fungin has been shown to be non-inferior to liposomal amphotericin B for the empiric treatment of prolonged neutropenic fever.rnAnother strategy that is widely used to decrease the impact of fungal infections in patients with prolonged neutropenia is prophylaxis with fluconazole. Fluconazole prophylaxis in patients undergoing allogeneic bone marrow transplantation and continued for 75 days after transplantation has been shown to reduce candidemia rates and provide a mortality benefit.