***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This open , r and omized , controlled study was design ed to assess the efficacy of fluconazole in comparison with oral amphotericin B in preventing clinical ly suspected fungal infection . A total of 178 chemotherapy-induced neutropenic episodes expected to last more than 10 days in 51 patients with haematological malignancies were r and omly treated with fluconazole , 200 mg once a day , or amphotericin B , 800 mg three times a day orally . Defining the end points as ( 1 ) documented fungal infection or ( 2 ) use of empiric intravenous amphotericin B for suspected fungal infection including an episode of fever lasting more than 5 days or fever developed during the use of broad-spectrum antibiotics , no difference was observed between the two groups Thirty-one patients with malignancy and endoscopy-confirmed symptomatic esophageal c and idiasis were r and omly assigned to receive oral fluconazole , 200 mg once daily , or intravenous amphotericin B , 0.3 mg/kg , over 1 - 4 weeks . Clinical efficacy was determined weekly and follow-up esophageal endoscopy with biopsy and culture performed whenever possible . Both agents produced rapid resolution of symptoms , especially dysphagia and odynophagia . All 13 evaluable patients in the fluconazole group and 10/12 treated with amphotericin had clinical improvement . Endoscopy showed eradication of the fungus in all 11 patients undergoing repeat endoscopy , with cure or improvement of esophagitis . The incidence of adverse effects attributable to treatment was higher in the amphotericin group . The efficacy of oral fluconazole in esophageal c and idiasis appears to be equivalent to that of amphotericin , with fewer adverse reactions Abstract Objective : To test the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion . Design : R and omised , controlled , non-blinded , single centre study . Setting : University hospital providing tertiary clinical care . Patients : 80 mostly neutropenic patients with refractory fever and suspected or proved invasive fungal infections . Intervention : Patients were r and omised to receive 0.97 mg/kg amphotericin B by continuous infusion over 24 hours or 0.95 mg/kg by rapid infusion over four hours . Main outcome measures : Patients were evaluated for side effects related to infusion , nephrotoxicity , and mortality up to three months after treatment . Analysis was on an intention to treat basis . Results : Patients in the continuous infusion group had fewer side effects and significantly reduced nephrotoxicity than those in the rapid infusion group . Overall mortality was higher during treatment and after three months ' follow up in the rapid infusion than in the continuous infusion group . Conclusion : Continuous infusions of amphotericin B reduce nephrotoxicity and side effects related to infusion without increasing PURPOSE To compare the efficacy and safety of fluconazole and amphotericin B as empiric antifungal therapy of febrile neutropenic patients with cancer . PATIENTS AND METHODS A total of 317 neutropenic patients ( < 500 cells/mm3 ) with persistent or recrudescent fever despite 4 or more days of antibacterial therapy were r and omly assigned to receive either fluconazole ( 400 mg intravenously once daily ) or amphotericin B ( 0.5 mg/kg once daily ) . Patients were evaluated for the efficacy and safety of each drug by clinical criteria , frequent cultures and radiological procedures , and laboratory values . A response was classified as satisfactory at the end of therapy if the patient was afebrile , had no clinical or microbiological evidence of fungal infection , and did not require study termination due to lack of efficacy , drug toxicity , or death . RESULTS A satisfactory response occurred in 68 % of the patients treated with fluconazole ( 107 of 158 patients ) and in 67 % of patients treated with amphotericin B ( 106 of 159 patients ) . Progressive or new fungal infections during therapy occurred in 13 ( 8 % ) patients treated with fluconazole ( 8 with C and ida , 5 with Aspergillus ) and in 10 ( 6 % ) patients treated with amphotericin B ( 5 with C and ida , 3 with Aspergillus , 2 with other fungi ) . Adverse events related to study drug ( especially fever , chills , renal insufficiency , electrolyte disturbances , and respiratory distress ) occurred more often in patients treated with amphotericin B ( 128 [ 81 % ] of 159 patients ) than patients treated with fluconazole ( 20 [ 13 % ] of 158 patients , P = 0.001 ) . Eleven ( 7 % ) patients treated with amphotericin B but only 1 ( 1 % ) patient treated with fluconazole were terminated from the study owing to an adverse event ( P = 0.005 ) . Overall mortality ( 27 [ 17 % ] patients treated with fluconazole versus 34 [ 21 % ] patients treated with amphotericin B ) and mortality from fungal infection ( 7 [ 4 % ] patients treated with fluconazole versus 5 [ 3 % ] patients treated with amphotericin B ) were similar in each study group . CONCLUSIONS Intravenous fluconazole can be an effective and safe alternative to amphotericin B for empiric antifungal therapy in many febrile neutropenic patients . However , because fluconazole may be ineffective in the treatment of Aspergillus , patients at risk for that infection should be evaluated by chest radiograph , computed tomographic scanning , and cultures before the use of empiric fluconazole therapy ABSTRACT In a prospect i ve , r and omized clinical trial , the toxicity of 1 mg of amphotericin B ( AmB ) per kg of body weight per day infused in 5 % dextrose was compared with that of AmB infused in lipid emulsion in children with malignant disease . In an analysis of 82 children who received a full course of 6 days or more of AmB ( 117 courses ) , it was shown that there were significant increases in plasma urea and creatinine concentrations and in potassium requirement after 6 days of therapy with both AmB infused in dextrose and AmB infused in lipid emulsion , with there being no difference between the two methods of AmB administration . An intent-to-treat comparison of the numbers of courses affected by acute toxicity ( fever , rigors ) and chronic toxicity ( nephrotoxicity ) also indicated that there was no significant difference between AmB infused in dextrose ( 78 courses ) and AmB infused in lipid emulsion ( 84 courses ) . The pharmacokinetics of AmB  were investigated in 20 children who received AmB in dextrose and 15 children who received AmB in lipid emulsion .  Blood sample s were collected up to 24 h after administration of the first dose , and the concentration of AmB in plasma was analyzed by a high-performance liquid chromatography assay . The clearance ( CL ) of AmB in dextrose ( 0.039 ± 0.016 liter · h−1 · kg−1 ) was significantly lower ( P < 0.005 ) than the CL of AmB in lipid emulsion ( 0.062 ± 0.024 liter · h−1 · kg−1 ) . The steady-state volume of distribution for AmB in dextrose ( 0.83 ± 0.33 liter · kg−1 ) was also significantly lower ( P < 0.005 ) than that for AmB in lipid emulsion ( 1.47 ± 0.77 liter · kg−1 ) . Although AmB in lipid emulsion is apparently cleared faster and distributes more widely than AmB in dextrose , this study did not reveal any significant advantage with respect to safety and tolerance in the administration of AmB in lipid emulsion compared to its administration in dextrose in children with malignant disease systemic fungal infections are a major problem in bone marrow transplant recipients who have prolonged neutropenia or who receive high-dose corticosteroids . prophylaxis with fluconazole or low-dose amphotericin b reduces , but does not eliminate these infections . to determine which prophylactic agent is better , we performed a prospect i ve r and omized study . patients undergoing allogeneic ( related or unrelated ) or autologous marrow or peripheral stem cell transplantation were r and omized to receive fluconazole ( 400 mg/day p.o . or i.v . ) or amphotericin b ( 0.2 mg/kg/day i.v . ) beginning 1 day prior to stem cell transplantation and continuing until recovery of neutrophils to > 500/μl . patients were removed from their study drug for drug-associated toxicity , invasive fungal infection or suspected fungal infection ( defined as the presence of fever > 38 ° C without positive culture while on broad-spectrum anti-bacterial antibiotics ) . Proven or suspected fungal infections were treated with high-dose amphotericin B ( 0.5–0.7 mg/kg/day ) . Patients were r and omized at each institution and stratified for the type of transplant . The primary end-point of the study was prevention of documented fungal infection ; secondary endpoints included fungal colonization , drug toxicity , duration of hospitalization , duration of fever , duration of neutropenia , duration and total dose of high-dose amphotericin B and overall survival to hospital discharge . From July 1992 to October 1994 , a total of 355 patients entered into the trial with 159 patients r and omized to amphotericin B and 196 to Fluconazole . Patient groups were comparable for diagnosis , age , sex , prior antibiotic or antifungal therapy , use of corticosteroids prior to transplantation and total duration of neutropenia . Amphotericin B was significantly more toxic than Fluconazole especially in related allogeneic transplantation where 19 % of patients developed toxicity vs 0 % of Fluconazole recipients ( p < 0.05 ) . approximately 44 % of all patients were removed from prophylaxis for presumed fungal infection . proven fungal infections occurred in 4.1 % and 7.5 % of fluconazole and amphotericin-treated patients , respectively . proven fungal infections occurred in 9.1 % and 14.3 % of related allogeneic marrow recipients receiving fluconazole or amphotericin b , respectively , and 2.1 % and 5.6 % of autologous marrow recipients receiving fluconazole or amphotericin b , respectively ( P > 0.05 ) . In this prospect i ve trial , low-dose amphotericin B prophylaxis was as effective as Fluconazole prophylaxis , but Fluconazole was significantly better tolerated . Bone Marrow Transplantation ( 2000 ) 25 , 853–859 Background . Fungal infection is a frequent and often fatal complication in patients undergoing remission induction therapy for acute leukemia . Although c and idiasis is the most common infection , mold infections are increasing in frequency . Fluconazole ( FLU ) is a new anti‐fungal agent that has been used successfully to treat C and ida infections and has modest activity against aspergillosis in animal models . Subtherapeutic doses of amphotericin B ( AMB ) have been considered effective as prophylaxis in these patients . This study was design ed to compare the efficacy and toxicity of these agents as anti‐fungal prophylaxis In a prospect i ve r and omized study the efficacy of fluconazole ( 50 mg in one single daily dose ) was compared with oral amphotericin B in suspension and tablets ( each 200 mg four times daily ) for prevention of colonization and subsequent infection by yeasts in 50 patients undergoing remission induction treatment for acute leukaemia . All patients received ciprofloxacin for prevention of bacterial infections .  Fluconazole was as effective as amphotericin B in preventing severe local and disseminated fungal disease ( one documented and one highly suspected infection in each group of patients ) . Fluconazole effectively prevented yeast colonization of the oropharynx but was less effective than amphotericin B in preventing colonization of the lower alimentary tract . Fifty-two percent of patients receiving fluconazole had persistent positive stool cultures as compared to 4 % in the amphotericin B group ( P less than 0.01 ) . Fluconazole was better tolerated than amphotericin B. One patient developed an extended rash leading to the termination of fluconazole Forty patients with acute leukemia ( age 16 - 71 years , 13 females , 27 males ) with induced neutropenia due to chemotherapy received either 50 mg fluconazole or 800 mg amphotericin B per day orally as prophylaxis against fungal infection . Nasal and genital swabs , mouth washings , urine , stool and blood serum were taken for mycological and serological examination before and weekly during one episode of neutropenia ( less than 10(9 ) granulocytes/l ) per patient . The quantitative determination of the yeast concentration in stool specimens demonstrated that amphotericin B led to intestinal yeast count reduction in only one third of the patients and could not prevent the increase of the intestinal yeast flora in another third 
    Output:
    
Furthermore , amphotericin B was not given under optimal circumstances , with premedication to reduce infusion-related toxicity , slow infusion , and with fluid , potassium and magnesium supplements to prevent nephrotoxicity .