Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever.
Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever.
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DOI：
10.1056/nejm200201243460403
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发表时间：
2002-01-24
影响因子：
158.5
通讯作者：
Lee, J
中科院分区：
文献类型：
--
作者：
Walsh, TJ;Pappas, P;Lee, J
背景资料：中性粒细胞减少和持续发热的患者通常经验性地用阿替霉素B或脂质体阿替霉素B治疗，以预防侵袭性真菌感染。抗真菌triazoles提供了一个潜在的安全和有效的alternate.Methods：在一个随机的，国际的，多中心的试验，我们比较伏立康唑，一个新的第二代三唑，与脂质体阿替霉素B经验性的抗真菌therapy.Results：共837例（415分配到伏立康唑和422到脂质体阿替霉素B）进行了评估成功的治疗。伏立康唑组的总成功率为26.0%，脂质体阿替霉素B组为30.6%（差异的95%置信区间为-10.6至1.6个百分点）;这些成功率与预防性抗真菌治疗或使用集落刺激因子无关。伏立康唑组的突破性真菌感染发生率低于脂质体阿替霉素B组（8例[1.9%] vs. 21例[5.0%]，P = 0.02）。伏立康唑组发生严重输液相关反应的病例较少（P
Background: Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative.Methods: In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy.Results: A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, -10.6 to 1.6 percentage points); these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors. There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal amphotericin B (8 [1.9 percent] vs. 21 [5.0 percent], P=0.02). The voriconazole group had fewer cases of severe infusion-related reactions (P