Randomized Trial of Fluconazole versus Nystatin for the Prophylaxis of Candida Infection following Liver Transplantation

Abstract

A prospective, randomized, multicenter study addressed the safety and efficacy of fluconazole therapy in 143 liver transplant patients. Seventy-six patients received daily oral fluconazole (100 mg), and 67 received nystatin (4 X 10(6) U) during the first 28 days after transplantation. Candida colonization occurred in 25% and 53% of patients in the fluconazole and nystatin groups, respectively (P = .04), and 13% and 34% of patients in the respective groups had Candida infections (P = .022). Of these patients, 10.5% in the fluconazole group and 25.3% in the nystatin group had superficial candidal infections (P = .024). Invasive candidiasis developed in 2 patients in the fluconazole group (2.6%) and 6 in the nystatin group (9.0%) (P = .12). There was no increased hepatotoxicity, cyclosporine interaction, or emergence of clinically relevant resistant Candida strains attributable to fluconazole. Thus, oral fluconazole (100 mg) is safe and reduces Candida colonization and infection after liver transplantation.

Preemptive Treatment of Fungal Infection Based on Plasma (1 → 3)β-D-Glucan Levels after Liver Transplantation

“…Additionally more frequent evaluation with lower cutoff level might increase the efficiency of our strategy. The incidence of invasive fungal infection in our series (13%) was slightly lower than those in reports in which no prophylactic treatment was administered [5][6][7][8][9] and similar to those in reports based on prophylaxis management [11][12][13][14][15][16], and the mortality rate due to proven invasive fungal infection in the present study was only 4% (1/24). Although renal impairment and mild gastrointestinal intolerance due to the drugs were observed in 28% (11/40) of patients during the preemptive treatment, they were transient and reversible.…”

“…To further decrease the incidence and mortality of invasive fungal diseases, some prophylactic regimens include fluconazole, amphotericin B, or trimethoprim-sulfamethoxazole [10][11][12][13]. More recently, oral itraconazole was reported to be an alternative effective prophylactic agent [14][15][16].…”

Infectious complications after OKT3 induction in liver transplantation

“…Lumbreras et al have also shown that oral fluconazole is effective in reducing Candida colonization and infection after liver transplantation. 10 One potential drawback of fluconazole prophylaxis would be the emergence of infections secondary to resistant fungi, especially C. glabrata. 11 This has not been problematic in our patients.…”

Prevention of Fungal and Hepatitis Virus Infections in Liver Transplantation

“…for the first 4 weeks after liver transplantation reduced colonization and superficial infection, and a trend toward reduction of invasive fungal infection was seen. Most important, when fluconazole was administered at this dose, it was well tolerated and safe, and did not interfere with cyclosporine levels [13]. A second, larger study published years later demonstrated that fluconazole administered at a dosage of 400 mg per os q.d.…”

“…Two randomized controlled studies have shown the efficacy of oral fluconazole in the prevention of invasive fungal infection caused by Candida species [7,13]. In one study, fluconazole administered at a dosage of 100 mg per os q.d.…”