Therapeutic Approaches in Patients With Candidemia. Evaluation in a Multicenter, Prospective, Observational Study

Arch Intern Med. 1995 Dec 11-25;155(22):2429-35.

Abstract

Objectives: To evaluate the morbidity and mortality of Candida fungemia and to assess the efficacy of low- vs high-dose amphotericin B and fluconazole vs amphotericin B in patients with candidemia.

Methods: Multicenter, prospective, observational study of 427 consecutive patients with candidemia.

Results: The mortality rate for patients with candidemia was 34%. The mortality rate for patients with catheter-related candidemia in whom the catheters were retained was significantly higher than that of patients in whom the catheters were removed (41% vs 21%, P < .001). We found no overall difference in mortality in patients treated with low-dose (total amphotericin B dose of < or = 500 mg) (13%) vs high-dose amphotericin B (total amphotericin B dose of > 500 mg) (15%), but the group treated with a low dose had fewer side effects (40%) than those treated with a high dose (55%) (P = .03). Fluconazole was as efficacious as amphotericin B in the therapy of candidemia, even when stratified by risk factors for mortality. Fewer side effects were seen with fluconazole (12%) compared with amphotericin B (44%) (P < .001).

Conclusions: In selected patients with candidemia, low-dose amphotericin B was as efficacious as high-dose amphotericin B. Based on other studies and ours, fluconazole seems to be an alternative therapeutic option to amphotericin B in selected patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / therapeutic use*
  • Candidiasis / drug therapy*
  • Candidiasis / etiology
  • Candidiasis / mortality
  • Catheters, Indwelling / adverse effects
  • Fluconazole / therapeutic use*
  • Fungemia / drug therapy*
  • Fungemia / etiology
  • Fungemia / mortality
  • Humans
  • Middle Aged
  • Prospective Studies
  • Risk Factors

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole