Antifungal Prophylaxis and Pre-Emptive Therapy
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In recent years, several reports have underlined the increasing role of fungal infections as a cause of morbidity and mortality in hospitalized non-haematological patients. For this reason, and also in light of the high mortality rate associated with these infections, chemoprophylaxis has been advocated for surgical patients hospitalized in intensive care units (ICUs). The available evidence suggests that the triazoles fluconazole and itraconazole are able to decrease Candida colonization and possibly infection compared with placebo, but this result has only been obtained in high-risk patients undergoing repeated surgical procedures for tertiary peritonitis. Consequently, triazole antifungal prophylaxis should be used with caution, and only in patients at high risk of invasive candidiasis, including high-risk surgical and ICU patients. A pre-emptive approach, defined as initiating antifungal treatment without confirmation of fungal infection, seems to be effective and safe.
The author thanks Melanie Gatt of Wolters Kluwer Pharma Solutions who provided assistance with English language editing. This assistance was funded by Pfizer.
The author has served as consultant for Pfizer, Merck, Astellas, Schering-Plough and Gilead, and has received honoraria from the same companies. He has also received research grants from Pfizer and Gilead.
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