Breakthrough Zygomycosis during Empirical Voriconazole Therapy in Febrile Patients with Neutropenia

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Abstract
Sir—Voriconazole, a novel, wide-spectrum triazole, is considered to be superior to amphotericin B in the treatment of infections caused by Aspergillus species [1] and to be equally as effective as amphotericin B in empirical antifungal therapy in cases of febrile neutropenia [2]. Nevertheless, because of its high cost, it is not widely used in Israel. During the late fall of 2003, there was a temporary shortage in the supply of amphotericin B deoxycholate in Israel that lasted for several weeks. During this period, voriconazole was used for empirical antifungal treatment in high-risk cases involving neutropenic patients in our medical center (Rambam Medical Center; Haifa, Israel). We report 2 patients with cases of invasive zygomycosis diagnosed in our hematology ward during this period who received this treatment.