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The Answer Is In: Fluconazole Prophylaxis Is Not Beneficial for Intensive Care Unit Patients without Neutropenia

Thomas Fekete, MD
[+] Article, Author, and Disclosure Information

From Temple University School of Medicine, Philadelphia, PA 19140.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Thomas Fekete, MD, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140; e-mail, tomfeke@temple.edu.

Ann Intern Med. 2008;149(2):140-141. doi:10.7326/0003-4819-149-2-200807150-00011
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The prevention of hospital infections in high-risk environments, such as intensive care units (ICUs), is a major goal of the patient safety movement. Fungal infections in the ICU—particularly candidemia—are especially troubling because they disproportionately affect the highest-risk patients and therefore inflict major morbidity and mortality. Although preventing these infections is a worthy goal, the specific strategy of using chemoprophylaxis has remained controversial, because we have an incomplete understanding of the risks, benefits, and costs of this approach, despite the availability of well-tolerated systemic antifungal drugs, such as fluconazole (1). The absence of conclusive evidence invites clinicians to make their own conclusion about the merit of this approach. As a result, 1 of 2 groups of patients (those who receive or do not receive prophylactic fluconazole) may be at avoidable risk—we just do not know which group. We need a high-quality study about this practice.

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