Antifungal Treatments in Adult Haematology Patients - Guidelines for the use of
|Last review: 27/12/2017|
|Next review: 27/12/2020|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2017|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guidelines for the use of Antifungal Treatments in Adult Haematology Patients
Invasive fungal disease (IFD)
|Empirical Antimicrobial Treatment|
There are at least two published comparisons of different doses of Ambisome in treating IFD. One of these demonstrates similar efficacy for Ambisome at 1 mg/kg/day vs. 4 mg/kg/day (Ellis et al. 1998) and the other shows no difference in outcome between Ambisome at 3 and 10 mg/kg/day (Cornely et al. 2007). Although the licensed dose for Ambisome in proven/probable fungal infection is 1-3 mg/kg/day, the licensed dose in febrile neutropenia, in which most patients do not have a fungal infection, is 3 mg/kg/day (presumably based on Prentice et al., 1997). Given the evidence of similar efficacy between Ambisome at 1 and 4 mg/kg/day an empiric Ambisome dose of 1 mg/kg/day is recommended in this guideline, whilst awaiting further results.
|Duration of Treatment|
It is recommended that treatment of IPA be continued for at least 6–12 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence
|Please contact Microbiology if the patient is not responding to the recommended antimicrobial regimens.|
|Clinical condition:||Use of antifungal agents in adult haematology patients|
|Target patient group:||Adults|
|Target professional group(s):||Secondary Care Doctors
- Ascioglu S, Rex JH, De Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clinical Infectious Diseases, 2002;34:7-14.
- Cornely, O. A., et al. Liposomal amphotericin B as initial therapy for invasive mold infection: a randomised trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clinical Infectious Diseases 2007;44:1289-97.
- De Pauw et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group Clinical Infectious Diseases 2008;46:1813-21.
- Ellis, M., et al. An EORTC international multicenter randomized trial (EORTC number 19923) comparing two dosages of liposomal amphotericin B for treatment of invasive aspergillosis. Clinical Infectious Diseases 1998;27:1406-12.
- Prentice AG, Glasmacher A, Hobson RP, Schey S , Barnes RA, Donnelly JP, Jackson G. Guidelines on the management of invasive fungal infection during therapy for haematological malignancy. British Committee for Standards in Haematology 2008; published on line at http://www.bcshguidelines.com/pdf/IFI_therapy.pdf
- Prentice, H. G., et al. A randomized comparison of liposomal versus conventional amphotericin B for the treatment of pyrexia of unknown origin in neutropenic patients. British Journal of Haematology1997;98;711-18.
- Walsh, T. J., et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. New England Journal of Medicine 1999;340: 764-71.
- Patterson, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 63(4):e1-e60.
- Maertens JA, et al. 2016 Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet. 387:760-9
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Improving Antimicrobial Prescribing Group
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