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March 14, 1977

Disseminated Candidiasis in a Patient With Acute Leukemia: Successful Treatment With Miconazole

JAMA. 1977;237(11):1124-1125. doi:10.1001/jama.1977.03270380068025

THE ADMINISTRATION of chemotherapy to patients with adult acute nonlymphocytic leukemia presently yields a 50% to 60% complete remission rate.1 Death from infection remains a major factor in preventing a higher proportion of patients from obtaining a complete remission.2 Candidiasis is the most frequent fungal infection in patients with leukemia3 and is often difficult to treat despite the use of amphotericin B with or without flucytosine. Amphotericin B may cause true anaphylaxis, fever, chills, hypotension, skin rash, nausea, vomiting, anorexia, anemia, azotemia, and renal tubular acidosis.4,5

Miconazole nitrate is a synthetic 1-phenethylimidazole derivative, 1-2,4-dichloro-β(2,4-dichlorobenzyloxy) phenethylimidazole nitrate with broad-spectrum antifungal and antibacterial activity.6 Miconazole has been used in the treatment of coccidioidomycosis with moderate success.7 Phlebitis at the site of infusion has been the only recognized side effect and can often be avoided by the use of a central venous catheter.

We report here the