The Role of Fluconazole Prophylaxis Regimen and the Regimes Chosen by the Patient’s Risk of Fungal Infection in Reducing the Infection Rate after Bone Marrow Transplantation.

Objective: Invasive fungal infections (IFI) in bone marrow transplant (BMT) recipients are common and lethal. Fluconazole was the choice prophylaxis previously, but recent strategy utilization antifungal drugs according to the risk of IFI in patients undergoing transplantation. In this study we aim to evaluate the efficacy of fluconazole prophylaxis regimen and the regimes chosen by the patient’s risk of IFI. Materials and Methods: We evaluated 376 patients with BMT. Patients were divided into those treated before 2012 with fluconazole prophylaxis (group I, n=206) or those undergone transplantation after 2012 and received fluconazole, voriconazole and posaconazole prophylaxis according their risk of fungal infection (group II, n=170). Results: Group I was significantly younger (p=0.007), less smoker (p=0.01), received more autologus transplant (p=0.001) and mostly high risk patient for infection (p<0.001). Group I had significantly higher duration of fever (p=0.004) and increased WBC (p=0.02), longer length of stay (p=0.001), more proven and less probable fungal infections (p=0.008) and higher hepatic complications (p=0.003). There was no significant difference in fungal related and overall mortality rate between groups. Conclusion: The use of prophylaxis based on risk of fungal infection in patients undergoing BMT results in reduce fungal infections, duration of fever and accelerate the engraftment and patient discharge.