Guidelines for Complications of Cancer Treatment Vol VIII Part B

Duration of treatment may depend upon clinical course,neutropenia recovery and toxicities.Documented Appropriate antibiotic for isolatedinfection pathogen Consider G-CSFConsider granulocyte transfusion forlife threatening bacterial andfungal infectionsTherapy for invasive fungal infectionsInvasive Candidiasis- (level-2)Invasive Candida infection is an important fungal infection.The crude mortality rate for candidemia varies from 23-50%.Fluconazole, AmphotericinB, Voriconazole and Caspofunginmay be used for invasive candidiasis. It appears thatcaspofungin had favourable response rate and better safetyprofile as compared to Amphotericin B. As number of patientswith neutropenia in the studies evaluating these drugs ininvasive candidiasis is small, the optimal therapy for thesepatients remains undefined.Invasive Aspergillosis: (level-2)Invasive Aspergillosis is common in patients with prolongedneutropenia. Voriconazole has better efficacy as compared toamphotericin B. In neutropenic patients also response washigher and is considered standard of care. Other antifungalsmay also be used eg- ampotericin B, Lipid preparation ofamphotericin B, caspofungin. Combination antifungalsvoriconazole with caspofungin, amphotericin B withcaspofungin has shown better efficacy as compared to singleagent in smaller trials. At present it is not possible torecommend combination antifungals for aspergillosis.380