Patients were identified either by searching the microbiology laboratory database or through direct referral from primary oncology services to the Infectious Diseases Consultative Services. The most common species identified were (seven patients, 35%). Five patients were treated with 600 mg/day, whereas 15 patients received 800 mg/day. The median APACHE II score at the onset of candidemia was 12 (range 6–24). Of 19 patients whose quantitative data were available, eight (42%) had high-grade candidemia [≥200 colony forming units (CFU)/ml]. Fifteen (83%) of 18 isolates were fluconazole susceptible, and two (both (MIC 64.0) infection responded to HDF. Central venous catheters were removed from all patients with ≥10 CFU/ml candidemias. All patients with high-grade candidemias responded to HDF. The median duration of HDF therapy was 16 (range 6–42) days. Although our data are limited, HDF appears to be well tolerated and may be associated with higher response rates than standard-dose fluconazole in a selected group of patients with solid tumors and candidemia caused by species that are susceptible to this triazole. Triazole drugs are widely used in cancer patients for prophylaxis and treatment of life-threatening invasive fungal infections. Fluconazole, available for over two decades, is safe and effective in patients with cancer; however, the excellent safety profile of fluconazole may not be applicable to the newer triazoles. Itraconazole, voriconazole and posaconazole are associated with adverse events, and drug interactions frequently occur, particularly in cancer patients, since the triazoles and many drugs used in cancer chemotherapy are metabolized via a common metabolic pathway, the hepatic cytochrome P450 system. Close monitoring for drug interactions is needed when triazoles are used with anti-neoplastic drugs and dosage modification of the triazole or its discontinuation may be required. Monitoring of triazole serum concentrations is becoming an important aspect of management to minimize toxicity and ensure efficacy. Cancer patients receiving chemotherapy that can compromise their immune system are at high risk of developing invasive fungal infections. This has resulted in increased clinical demand for newer and safer antifungal drugs.
Fluconazole preferentially inhibits fungal cytochrome P-450 sterol C-14 alpha-demethylation, resulting in the accumulation of fungal 14 alpha-methyl sterols, the. Apr 19, 2018. Fluconazole is also used to prevent fungal infection in people who have a weak immune system caused by cancer treatment, bone marrow.