Back to Search
Start Over
Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever
- Source :
- The New England journal of medicine. 346(4)
- Publication Year :
- 2002
-
Abstract
- Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative.In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy.A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, -10.6 to 1.6 percentage points); these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors. There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal amphotericin B (8 [1.9 percent] vs. 21 [5.0 percent], P=0.02). The voriconazole group had fewer cases of severe infusion-related reactions (P0.01) and of nephrotoxicity (P0.001). The incidence of hepatotoxicity was similar in the two groups. Patients receiving voriconazole had more episodes of transient visual changes than those receiving liposomal amphotericin B (22 percent vs. 1 percent, P0.001) and more hallucinations (4.3 percent vs. 0.5 percent, P0.001). Parenteral voriconazole was changed to the oral formulation in 22 percent of the voriconazole group, with a reduction in the mean duration of hospitalization by one day in all patients (P=0.17) but by two days in patients at high risk (P=0.03).Voriconazole is a suitable alternative to amphotericin B preparations for empirical antifungal therapy in patients with neutropenia and persistent fever.
- Subjects :
- Adult
Male
medicine.medical_specialty
Antifungal Agents
Neutropenia
Adolescent
Fever
Pharmacology
Gastroenterology
law.invention
Randomized controlled trial
law
Internal medicine
Multicenter trial
Amphotericin B
Neoplasms
medicine
Humans
Prospective Studies
Prospective cohort study
Child
Infusions, Intravenous
Aged
Voriconazole
Aged, 80 and over
business.industry
General Medicine
Middle Aged
Triazoles
medicine.disease
Anti-Bacterial Agents
Pyrimidines
Mycoses
Chronic Disease
Liposomal amphotericin
Female
Chemical and Drug Induced Liver Injury
business
Fluconazole
medicine.drug
Subjects
Details
- ISSN :
- 15334406
- Volume :
- 346
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- The New England journal of medicine
- Accession number :
- edsair.doi.dedup.....3489ae1b103f01e5a3d0ff26ef629b61