Drugs & Aging

, Volume 17, Issue 5, pp 339–351 | Cite as

Fungal Infections in Patients With Neutropenia

Challenges in Prophylaxis and Treatment
  • Raoul HerbrechtEmail author
  • Ségolène Neuville
  • Valérie Letscher-Bru
  • Shanti Natarajan-Amé
  • Olivier Lortholary
Disease Management


Fungal infections are a leading cause of mortality in patients with neutropenia. Candidiasis and aspergillosis account for most invasive fungal infections.

General prophylactic measures include strict hygiene and environmental measures. Haemopoietic growth factors shorten the duration of neutropenia and thus may reduce the incidence of fungal infections. Fluconazole is appropriate for antifungal prophylaxis and should be offered to patients with prolonged neutropenia, such as high-risk patients with leukaemia undergoing remission induction or consolidation therapy and high-risk stem cell transplant recipients.

Empirical antifungal therapy is mandatory in patients with persistent febrile neutropenia who fail to respond to broad-spectrum antibacterials. Intravenous amphotericin B at a daily dose of 0.6 to 1 mg/kg is preferred whenever aspergillosis cannot be ruled out. Lipid formulations of amphotericin B have demonstrated similar efficacy and are much better tolerated.

Fluconazole is the best choice for acute candidiasis in stable patients; amphotericin B should be used in patients with unstable disease. Use of fluconazole is restricted by the existence of resistant strains (Candida krusei and, to a lesser extent, C. glabrata).

Amphotericin B still remains the gold standard for invasive aspergillosis. Lipid formulations of amphotericin B are effective in aspergillosis and because they are less nephrotoxic are indicated in patients with poor renal function. Itraconazole is an alternative in patients who have good intestinal function and are able to eat.

Mucormycosis, trichosporonosis, fusariosis and cryptococcosis are less common but require specific management.

New antifungal agents, especially new azoles, are under development. Their broad in vitro spectrum and preliminary clinical results are promising.


Fluconazole Itraconazole Aspergillosis Invasive Aspergillosis Invasive Fungal Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Raoul Herbrecht
    • 1
    Email author
  • Ségolène Neuville
    • 2
  • Valérie Letscher-Bru
    • 3
  • Shanti Natarajan-Amé
    • 1
  • Olivier Lortholary
    • 2
    • 4
  1. 1.Département d’Hématologie et d’OncologieHôpitaux Universitaires de StrasbourgStrasbourgFrance
  2. 2.Unité de MycologieInstitut PasteurParisFrance
  3. 3.Institut de Parasitologie et de Pathologie TropicaleStrasbourgFrance
  4. 4.Service de Médecine Interne - Maladies Infectieuses et TropicalesHôpital AvicenneBobignyFrance

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