John H. Powers, MD; Karen M. Higgins, ScD
Disclaimer The opinions expressed in this letter are those of the authors and not necessarily those of the U.S. Food and Drug Administration.
Powers J., Higgins K.; Itraconazole versus Fluconazole for Antifungal Prophylaxis. Ann Intern Med. 2004;140:580. doi: 10.7326/0003-4819-140-7-200404060-00027
Download citation file:
Published: Ann Intern Med. 2004;140(7):580.
TO THE EDITOR:
Winston and colleagues (1) showed that studying a relatively small sample of high-risk patients may allow demonstration of a potential difference between prophylactic drugs. However, the results of their study may not be generalizable to patients receiving allogeneic hematopoietic stem-cell transplantation in other institutions with a lower rate of fungal infections. The rate of fungal infections with fluconazole was 2.4% in a recent trial of prophylaxis in allogeneic transplant recipients (2) compared with 25% in Winston and colleagues' trial.
This trial considered empirically treated patients and those who died as “successes.” Current diagnostic tests are not sensitive for diagnosis of invasive fungal infections before death (3). Therefore, in Winston and colleagues' study, empirically treated patients and those who died may have had occult invasive fungal disease. Even with autopsy data, it is difficult to distinguish between “fungal-related” mortality and death from other causes in such seriously ill patients. A decrease in “fungal-related” mortality but no difference in overall mortality implies that more patients receiving itraconazole died of non–fungal-related causes, one of which might have been unrecognized drug toxicity.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only