***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: OBJECTIVES : To evaluate the efficacy of low dose fluconazole treatment for the prevention of yeast colonization and infection in severely neutropenic patients . METHODS : An open r and omized trial , comparing fluconazole ( 100 mg per day ) with nystatin ( 800,000 IU per day ) , in a University Hospital setting . RESULTS : Antifungal prophylaxis was given during the period of neutropenia , defined as less than 500 polymorphonuclear cells (PMN)/mm3 ) . Thirty-six patients were r and omly assigned to fluconazole and 33 to nystatin treatment groups . New oropharyngeal colonizations were significantly reduced by fluconazole ( P=0.005 ) , and oropharyngeal infections occurred less frequently in the fluconazole group ( 3 % versus 16 % , P=0.07 ) . Stool colonization was identical between both groups . Systemic fungal infections were rare ; one fluconazole patient had pulmonary aspergillosis and one nystatin patient developped C and ida pseudotropicalis fungemia . Empiric amphotericin B was given with the same frequency in both groups . No side effects were associated with fluconazole . However , the administration of nystatin became impossible for three patients because of vomiting and lack of compliance . CONCLUSIONS : Fluconazole ( 100 mg per day ) is more effective than nystatin for the prevention of oropharyngeal yeast colonization . Comparison with results in the literature suggests that a 100-mg dose of fluconazole has similar effects to 200 or 400 mg per day Purpose The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by C and ida in hematopoietic cell transplant ( HCT ) patients was examined . Methods Prior to hematopoietic cell infusion , 40 patients receiving systemic fluconazole for prophylaxis were r and omized to receive either amphotericin B oral suspension or nystatin oral suspension , q.i.d . The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study . Oral examinations were conducted twice weekly , and adverse events and compliance were recorded . Cultures were taken for quantitative counts and species identification . C and ida isolates were assessed for resistance to the oral antifungal agents . Blood was collected for assessment of amphotericin B levels . Results and discussion Ulcerative mucositis occurred in 84.6 % of patients undergoing HCT , and no correlation was observed between the severity of mucositis and the presence of oral C and ida and the severity of mucositis . Systemic and topical antifungal treatment result ed in a decrease in the number of colonized patients ( 54.8 % before treatment ; 23.1 % during treatment ) ; however , oral colonization was not eliminated . Tolerability of the oral rinse products was limited , with greater noncompliance in the amphotericin B than the nystatin group . Reports of altered taste appeared to be greater in the amphotericin B group . Minimal absorption of amphotericin B was seen following oral rinsing ( serum levels 0.12–0.50 μg/ml ) , and no consistent changes in organism susceptibility to polyenes were seen . The results suggest that topical antifungal rinses may further control oropharyngeal colonization by C and ida in patients on systemic antifungals receiving HCT , but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance Fifty-six untreated patients with acute leukemia ( 38 acute myelogenous leukemia , 16 acute lymphoblastic leukemia , and 2 blast crisis of chronic granulocytic leukemia ) were r and omized on admission to one of three groups -- one to receive oral antic and idal prophylaxis through the period of remission induction chemotherapy with nystatin , another to receive natamycin , and the third to receive no antic and idal prophylaxis . Neither of the first two groups show any advantage over the last and it is concluded that provided gut sterilization regimes are not employed , prophylactic oral antic and idal treatment is of no value in these patients and should be reserved until there is clinical evidence of infection The goal of this prospect i ve r and omized single-center study was the comparison of safety and efficacy of high-dose oral/intravenous fluconazole ( 400 mg daily ) ( group A ) with oral nystatin plus miconazole inhalations ( group B ) in the prevention of fungal infections on a hemato-oncological isolation Ward . Of 157 patients admitted to the isolation ward during the study period only 90 ( 57 % ) were eligible for r and omization ; 22 ( 14 % ) had a fungal infection at admission . Of the 90 r and omized patients , 89 were evaluable , 43 in group A and 46 in group B. The age , sex , diagnosis , planned therapy and risk factors for fungal infections at admission as well as the duration of neutropenia were in the same proportions in both groups . Oral thrush and mucocutaneous c and idiasis were prevented in all patients of both groups , and 29 patients ( 32 % : 17 in group A , 12 in group B ) were discharged after successful prophylaxis ( NS ) . Empiric amphotericin B was given according to predetermined criteria to 45 patients ( 51 % : 23 group A , 22 group B ; NS ) . Fluconazole significantly delayed the time before the start of intravenous amphotericin B. It was begun after a median of 10 days ( 0–45 days , range ) of neutropenia below 0.5x109 granulocytes/l in group A and 7.5 days ( 0–26 , range ) in group B ( P<0.05 ) . The duration of successful prophylaxis was significantly longer in group A ( 26 days median ) than in group B ( 21 days , median ) ( P<0.05 ) . Systemic fungal infection was documented in 3 patients ( 1 group A , 2 group B ; NS ) . Colonisation with C and ida persisted for more than 14 days or occurred de novo after admission in 1 patient in group A and in 7 patients in group B ( NS ) . Oral nystatin had to be discontinued because of oral intolerance in 3 patients and fluconazol had to be stopped because of increased liver values in one patient . Compliance was worse ( P<0.01 ) in group B ; 82 % of the planned dose was given in group B compared to 99 % in group A. Both regimens successfully prevented oral fungal complications . Fluconazole was better tolerated and delayed the need for empiric amphotericin B. Neither approach cancelled the need for the empiric use of amphotericin B nor prevented fungal infections or colonization . Systemic fungal infections occur probably independently of oral or mucocutaneous c and idiasis The orointestinal yeast colonization of 46 children with newly diagnosed malignancies was studied prospect ively and longitudinally with quantitative cultures during remission induction chemotherapy . The initial colonization rate was 24 % ; only 28 % of the patients remained free of yeasts during their entire treatment although all of them continuously received oral polyenes as antifungal prophylaxis . A r and omized comparison of natamycin ( suspension , lozenges ) , nystatin ( suspension ) and amphotericin B ( suspension , lozenges ) failed due to serious problems with patient compliance . Natamycin was best accepted by the patients and natamycin lozenges were the most efficacious drug in the oral cavity . The effectivity of the suspensions of nystatin and amphotericin B was similar ; both were equally efficacious in the oral cavity and the gut . Assessment of faecal polyene concentrations by HPLC showed the highest results for amphotericin B ( mean 6808 microgram(-1 ) ) . Regularly performed C and ida serology ( indirect haemagglutination , indirect immunofluorescence and immunodiffusion precipitation ) revealed significant titre increases in 63 % of the patients . In six cases , the synopsis of clinical picture , culture and serology strongly suggested systemic yeast invasion Nystatin , one million units every four hours , was prospect ively studied as a prophylactic antifungal agent in 164 neutropenic patients who were not initially colonized by fungi : 104 received nystatin and 60 served as controls .  Fungal colonization occurred in 68/104 ( 65 % ) nystatin recipients and in 43/60 ( 71 % ) controls . However , nystatin significantly reduced multiple body site colonization and persistent oropharyngeal colonization . Despite these alterations in colonization profile , 16/104 ( 15 % ) nystatin recipients developed disseminated fungal infections , as compared to 5/60 ( 8 % ) control patients ( 0.5 greater than p greater than 0.1 , N.S ) . Differences in the clinical course of colonized and non-colonized patients were observed . Eighteen of 111 ( 16 % ) colonized patients had afebrile clinical courses as compared to 16/53 ( 30 % ) non-colonized patients ( p less than 0.05 ) . Twenty-nine of 93 ( 31 % ) febrile episodes in colonized patients failed to respond to empiric antibiotic therapy as compared to 3/37 ( 8 % ) episodes in non-colonized patients ( p less than 0.01 ) . Disseminated fungal infections were diagnosed in 19/111 ( 17 % ) of colonized patients , as compared to 1/53 ( 2 % ) non-colonized patients ( p less than 0.02 ) . We conclude that colonized patients are more likely to develop febrile clinical courses , to fail to respond to empiric antibiotic therapy , and to develop disseminated fungal infection .  Nystatin altered colonization patterns but did not prevent disseminated fungal infection The goal of reducing oral complications during  chemotherapy and bone marrow transplantation has received attention at several centers . The current r and omized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation  assessed the potential role of chlorhexidine , nystatin , and saline solution rinses to reduce the findings of oral mucositis , gingivitis , and oral infection . The results of this study did not show a reduction in mucositis with the use of these rinses . However , potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse A prospect i ve , r and omized , multicenter study addressed the safety and efficacy of fluconazole therapy in 143 liver transplant patients . Seventy-six patients received daily oral fluconazole ( 100 mg ) , and 67 received nystatin  ( 4 X 10(6 ) U ) during the first 28 days after transplantation .  C and ida colonization occurred in 25 % and 53 % of patients in the fluconazole and nystatin groups , respectively ( P = .04 ) , and 13 % and 34 % of patients in the respective groups had C and ida infections ( P = .022 ) . Of these patients , 10.5 % in the fluconazole group and 25.3 % in the nystatin group had superficial c and idal infections ( P = .024 ) . Invasive c and idiasis developed in 2 patients in the fluconazole group ( 2.6 % ) and 6 in the nystatin group ( 9.0 % ) ( P = .12 ) . There was no increased hepatotoxicity , cyclosporine interaction , or emergence of clinical ly relevant resistant C and ida strains attributable to fluconazole . Thus , oral fluconazole ( 100 mg ) is safe and reduces C and ida colonization and infection after liver transplantation A prospect i ve , r and omized study was conducted to determine if prophylactic antifungal agents prevented yeast colonization ( YC ) or yeast sepsis ( YS ) , or if they diminished mortality in 292 critically ill adult ( nontransplant/nonburned ) surgical and trauma patients admitted to the SICU for 48 hours or longer . Patients were r and omized to receive ( group I ) no therapy , ( group II ) clotrimazole 10 mg three times a day , ( group III ) ketoconazole 200 mg per day , or ( group IV ) nystatin 2 million units every 6 hours . For comparison patients were stratified by the criteria of Slotman and Burchard into high risk ( > or = 3 risk factors ) and low risk ( < 3 risk factors ) . Fifty patients ( 17 % ) had yeast colonization , nine ( 3.1 % ) had yeast sepsis , and 41 ( 14 % ) died . Stepwise logistic regression analysis of yeast colonization and sepsis using the variables APACHE II scores > 10 , need for ventilator support > 48 hours , and 14 risk factors ( Slotman and Burchard ) showed that treatment with three or more antibiotics , APACHE II > 10 , and ventilatory support > 48 hours were the only three variables that were significant predictors of yeast colonization and sepsis . There was no significant difference between the four groups with regard to YC ( 23 % , 18 % , 12 % , and 
    Output:
    
REVIEW ER 'S CONCLUSIONS Nystatin can not be recommended for prophylaxis or treatment of C and ida infections in immunodepressed patients