Vol.53 No.11 November 2005
Timing of antifungal therapy in patients with refractory fever receiving broad-spectrum antibiotics
Fourth Department of Internal Medicine, Teikyo University School of Medicine,
3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, Japan
Abstract
Fungal infection is still a life-threatning complication in patients with hematological malignancies or in those undergoing hematopoietic stem cell transplantation. Because of the poor prognosis of patients treated with amphotericin B after the confirmation of fungal infection, its empirical use is recommended for febrile neutropenic patients refractory to broad-spectrum antibiotics after 3-7 days. However, the actual incidence of fungal infection in these patients is unknown. Therefore, a considerable number of patients may have been overtreated using this approach. New drugs that are safer and more effective than amphotericin B, especially against Aspergillus, and newer diagnostic tools are now being introduced. The usefulness of empiric antifungal therapy is now being debated because of its high cost, especially using the new antifungal drugs. Recently, preemptive therapy and presumptive therapy were introduced in this field. Preemptive therapy is used for patients exhibiting early preclinical signs of fungal infection but no overt disease. Presumptive therapy is initiated for patients with fever refractory to broad-spectrum antibiotics who are positive for surrogate markers of fungal infection but do not have a probable/proven fungal infection. Appropriate approaches for early antifungal therapy in high-risk patients are discussed.
Key word
antifungal therapy, empiric therapy, preemptive therapy, presumptive therapy
Received
September 27, 2005
Accepted
October 7, 2005
Jpn. J. Chemother. 53 (11): 673-678, 2005
