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Fluconazole Prophylaxis in Patients with Leukemia
- Hidecki Akiyama, MD;
- Hisashi Sakamaki, MD; and
- Yasusuke Onozawa, MD
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TO THE EDITOR:
Winston and coworkers [1] describe a prophylactic effect of fluconazole against colonization and superficial infections caused by Candida species other than Candida krusei in patients with acute leukemia. They observed an increased incidence of colonization by C. krusei but not by Torulopsis glabrata in the fluconazole group. We use fluconazole (200 mg/d) from the day of initiation of chemotherapy until the day when the neutrophil count exceeds 0.5 109/L in patients with chemotherapy-induced neutropenia. Between January 1991 and October 1992, we obtained surveillance cultures of the stool in 31 patients with acute leukemia who were receiving fluconazole after chemotherapy. We found colonization by T. glabrata in 12 patients, by C. krusei in 1 patient, and by C. albicans in 2 patients. A 48-year-old man with acute myelogenous leukemia developed T. glabrata septicemia.
Surveillance cultures in 28 patients receiving amphotericin B syrup, 800 mg three times a day, during the same treatment period showed colonization by T. glabrata, C. krusei, and C. albicans in 1, 0, and 7 patients, respectively. Even though the data on the control group are not available, all patients were negative for fungus initially, suggesting the relative ineffectiveness of fluconazole against T. glabrata.
This high incidence of colonization by T. glabrata might be attributable to the use of lower-dose fluconazole or geographic differences. Because of reports of T. glabrata septicemia in patients receiving fluconazole [2-4], it is important to consider the risk for colonization and invasive infection by T. glabrata during fluconazole prophylaxis.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
