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*****************************************A randomized trial of voriconazole versus fluconazole prophylaxis for prolonged surgery.
The role of prophylactic antifungal therapy during prolonged surgical procedures is controversial. The purpose of the present study was to determine the efficacy of prophylactic antifungal therapy with voriconazole (VORI) for prolonged surgery. The efficacy of VORI and fluconazole (FLU) was compared in a randomized double-blind, multicenter study involving patients with a prolonged surgical procedure lasting at least 4 h and requiring general anesthesia. The first group of 166 patients received VORI prophylaxis (400 mg on the day of surgery and twice daily for 14 days thereafter) and the second group FLU (200 mg on the day of surgery and twice daily for 14 days thereafter). Cultures were obtained at baseline, during surgery, and 7 days after surgery. The primary endpoint was the difference in the rates of positive surgical site fungal cultures between the two groups. The patients’ characteristics were similar in the two groups. The overall rate of positive surgical site fungal cultures (33/98 patients; 33.7%) was similar in the two groups. The rate of positive surgical site fungal cultures was significantly lower in the VORI than in the FLU group during surgery (20/83 patients, 24.1% versus 12/83 patients, 14.5%; P = 0.024). The overall rate of positive fungal cultures was similar for any site in the two groups. Voriconazole prophylaxis significantly reduced positive surgical site fungal cultures during surgery in patients undergoing prolonged surgical procedures. The optimal dose and duration of VORI prophylaxis remain to be determined.España

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