Intravenous and oral itraconazole versus intravenous amphotericin B deoxycholate as empirical antifungal therapy for persistent fever in neutropenic patients with cancer who are receiving Broad-spectrum antibacterial therapy: A randomized, controlled trial

Abstract

Prolonged neutropenia is a major risk factor for invasive fungal infection (1–6). The incidence among neutropenic patients with cancer who are receiving intensive cytotoxic therapy ranges from 2% to 47%, depending on other concomitant risk factors (7). Mortality rates range from 35% to 90% (8). Fever may be the only clinical sign of infection, and definitive diagnosis is often problematic. Empirical therapy with amphotericin B deoxycholate reduces the relative risk for documented infection by 50% to 80% and overall mortality rates by 23% to 45% (1–2, 9–10). This practice is now standard in neutropenic patients with cancer who have persistent fever that does not respond to 3 to 7 days of treatment with broad-spectrum antibiotics (11)