Itraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients

ABSTRACTResults from randomised, controlled trials and routine clinical experience indicate that itraconazole can be more effective than fluconazole for prevention of invasive fungal infections in allogeneic stem-cell transplant patients. The effective and safe use of prophylactic itraconazole requires an appreciation of the drug's pharmacokinetics, the optimal dosing regimen, and potential drug interactions. Because of the erratic bioavailability of oral itraconazole capsules, only the intravenous (200 mg once-daily) and oral cyclodextrin solution (200 mg twice-daily) formulations of the drug should be used. Prophylaxis should be started after the completion of pre-transplant chemotherapy in order to avoid interactions with chemotherapeutic agents. Patients unable to tolerate oral itraconazole should be given intravenous itraconazole to maintain effective prophylaxis. Post-transplant interactions between itraconazole and immunosuppressive agents or other drugs are generally not problematic, can be easily managed, and need not limit the use of itraconazole. If these guidelines are followed, Aspergillus and other invasive fungal infections can be safely prevented in allogeneic stem-cell transplant patients