Comparison of fluconazole and posaconazole for fungal prophylaxis in high- risk patients with hematological malignity

Abstract

Objective: To compare the frequency of fungal infection and mortality rates in patients with hematological malignity and receiving either flucanazole (FLU) or posaconazole (POS) prophylaxis. Methods: This retrospective, observational study investigated fungal prophylaxis in patients with a high risk of invasive fungal infections (IFIs) and diagnosed with hematological malignity at our hospital hematology clinic between 01.01.2011 and 01.01.2013. FLU (n=70) was the prophylactic regimen between 2011 and 2012 which was replaced by POS (n=35) in the following period. The incidence and mortality rates of IFIs developing in the two periods were compared. Results: The incidence of IFI in patients administered FLU prophylaxis was 22/70 (31%), compared to 13/35 (37%) in the patients receiving POS. Incidence of invasive pulmonary aspergillosis (IPA) in the FLU group was 21/70 (31%), compared to 9/35 (26%) in the POS group. The mortality rate in the group receiving FLU prophylaxis was 17 (24%), compared to 4 (11%) in the POS group. The difference was attributed to causes other than fungal infection. Results of subgroup analysis performed for AML were similar to the general findings in terms of both incidences of fungal infection and of mortality levels. In multivariate analysis, mean duration of neutropenia was correlated with prophylaxis failure. Conclusion: We conclude that both agents can be successfully used in fungal infection prophylaxis for patients at high risk for IFI.