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Invasive Fungal Infection

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Neutropenic cancer patients are at high risk of developing invasive fungal infections (IFI), especially those who have extended periods of profound neutropenia (a). In particular, patients who have hematologic malignancies and receiving remission induction chemotherapy for acute myeloid leukaemia (AML) are at higher risk of having these invasive fungal infections (b). This risk of fungal infection increase in patients with prolonged duration of neutropenia, increased number of chemotherapy cycles and prolonged duration of using antibiotic (h). Unfortunately, IFI can results in inability of taking the consecutive chemotherapy cycle and substantial morbidity and mortality, with a high mortality rate reaching up to 90% (c,d). The Infectious Diseases …show more content…

(e,f, g ). Voriconazole has both oral and IV formulations while Posaconazole is available as an oral suspension, delayed-release tablets and, an IV formulation (h). Posaconazole doses is taken as oral suspension is taken 3 times daily or delayed-release tablet is taken once daily and IV infusion once daily (k). Voriconazole is taken as IV every 12 hours (k). A clinical trial had shown that posaconazole prevent the development of IFI more effectively compared to fluconazole or itraconazole as well as improve overall survival, but posaconazole was found to result in more serious side effects (i). One the other hand, there is no clinical trial conducted to know the effect of Voriconazole on AML patients (e). There is clinical trial conducted on patients who had hematopoietic cell transplantation, many of them have AML (j). The study compared between voriconazole versus fluconazole; there was less fungal infection (Aspergillus infections) in voriconazole group compared to fluconazole with no overall improvement in fungal-free survival period (j). Unfortunately, there is no clinical trial conducted to compare between posaconazole and Voriconazole. In addition to that, there is limited data about the pharmacoeconomics of using posaconazole

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