Hematogenous candidiasis. A review of therapeutic studies of fluconazole and amphotericin B and recommendations for management

Background. Hematogenous candidiasis is increasing in incidence and is associated with significant morbidity and mortality. Objectives. To evaluate the role of amphotericin B and fluconazole in the treatment of hematogenous candidiasis and to give recommendations for the management of this infection. Methods. A MEDLINE search of relevant publications was performed. Studies identified by the search which evaluate the role of fluconazole or amphotericin B as therapeutic regimens for hematogenous candidiasis were reviewed. Results. The results of two prospective randomized trials comparing fluconazole with amphotericin B suggest that fluconazole is as effective as amphotericin B and less toxic. While these data confirm the findings of several small series and retrospective studies that suggested a good activity of fluconazole in the treatment of hematogenous candidiasis, a definitive conclusion as to the equivalent efficacy of the two drugs across all populations cannot be substantiated. Conclusions. Given the acceptable efficacy of fluconazole and its superior safety profile, the use of this drug is recommended for the treatment of hematogenous candidiasis caused by fluconazole-susceptible species. Several important issues remain to be answered, such as the drug of choice for patients with neutropenia and those infected with the various non-albicans Candida species, the dosage-schedule and duration of antifungal therapy in low- and high-risk patients, and the role of the vascular catheters.