1. A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy-induced febrile neutropenia in children
- Author
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Mareva Giacchino, Simone Cesaro, Ottavio Ziino, Anna Pegoraro, Marcello Chiodi, Alfredo Pontillo, Fraia Melchionda, Nicola Santoro, Maurizio Aricò, Susanna Livadiotti, Giulio Andrea Zanazzo, Pietro Ragusa, Vincenzo Poggi, Désirée Caselli, Caselli, D, Cesaro, S, Ziino, O, Ragusa, P, Pontillo, A, Pegoraro, A, Santoro, N, Zanazzo, G, Poggi, V, Mareva, G, Livadiotti, S, Melchionda, F, Chiodi, M, and Aricò, M
- Subjects
Male ,medicine.medical_specialty ,Antifungal Agents ,Neutropenia ,Antineoplastic Agents ,Opportunistic Infections ,Lower risk ,Fever of Unknown Origin ,law.invention ,Echinocandins ,Lipopeptides ,chemistry.chemical_compound ,Randomized controlled trial ,Caspofungin ,law ,Amphotericin B ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,empirical antifungal therapy, children, cancer ,business.industry ,Patient Selection ,Infant ,Cancer ,Hematology ,Length of Stay ,medicine.disease ,Confidence interval ,Surgery ,Hospitalization ,Treatment Outcome ,Mycoses ,chemistry ,Child, Preschool ,Female ,business ,Empiric therapy ,Febrile neutropenia - Abstract
Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data, we performed a prospective, randomized, controlled trial that evaluated 110 neutropenic children with persistent fever. Those at high risk for invasive fungal infections (IFI) received caspofungin (Arm C) or liposomal amphotericinB (Arm B); those with a lower risk were randomized to receive Arm B, C, or no antifungal treatment (Arm A). Complete response to empirical antifungal therapy was achieved in 90/104 patients (86·5%): 48/56 at high risk (85·7%) [88·0% in Arm B; 83·9% in Arm C (P = 0·72)], and 42/48 at low risk (87·5%) [87·5% in control Arm A, 80·0% Arm B, 94·1% Arm C; (P = 0·41)]. None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response. IFI was diagnosed in nine patients (8·2%, 95% confidence interval, 3·8-15·0). This randomized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged
- Published
- 2012
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