Oral prophylaxis with miconazole or ketoconazole of invasive fungal disease in neutropenic cancer patients.

Ketoconazole or miconazole was randomly administered to 42 and 46 neutropenic patients respectively. Of the total number of stool cultures 12% were positive for yeasts in both groups; 4% of the total number of cultures from other sites (nose, throat, skin) were positive in both groups. Candida albicans was the most common isolate, but other fungal species were also identified. No patient developed fungemia; 5/88 patients developed severe oropharyngeal candidiasis while receiving prophylaxis. Among the 21 autopsies performed, 5 cases of pulmonary aspergillosis and 2 local and 1 disseminated candidiasis were demonstrated in 7 patients. Although there was no placebo group of patients in this study, post-mortem data suggest that miconazole or ketoconazole might reduce the incidence of disseminated candidiases in neutropenic patients.