***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*** 
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    Input: AIMS : To compare the efficacy of and tolerance to oral fluconazole and intraconazole in preventing fungal infection  in neutropenic patients with haematological malignancies . PATIENTS : 213 consecutive , afebrile adult patients treated with or without autologous stem cell transplantation for haematological malignancies . METHODS : A r and omised , double blind , single centre study . Patients were r and omly assigned to receive fluconazole 50 mg or itraconazole 100 mg , both twice daily in identical capsules . An intention to treat analysis was performed on 202 patients , 101 in each group . RESULTS : Microbiologically documented systemic fungal infections occurred in four patients in each group . Clinical fungal infection was thought to be present in seven recipients of fluconazole and four of itraconazole . In all 202 patients , 29 proceeded to intravenous amphotericin ( amphotericin B ) , 16 in the fluconazole group and 13 in the itraconazole group . Superficial fungal infection was seen only in three non-compliant patients in the fluconazole group . All these infections were oral . No major differences were noted in the isolates of fungi in mouth washes and fecal sample s. Overall mortality was 8.9 % ( 18 deaths ; seven in the fluconazole group , 11 in the itraconazole group ) . Mortality from microbiologically and clinical ly documented fungal infection was 4.5 % ( nine deaths ; three in the fluconazole group , six in the itraconazole group ) . Median time to suspected or proven fungal infection was 16 days in both groups . None of these comparisons reached statistical significance ( p < 0.05 ) . No major clinical toxicity was noted and compliance was excellent . CONCLUSIONS : In neutropenic patients treated for haematological malignancies with or without autologous stem cell transplantation , fluconazole and itraconazole in low doses result in a similar low frequency of fungal disease .  Fluconazole may be the preferable drug because of the smaller number of capsules and lack of need for timing relative to meals Goal of workThe aim of the study is to evaluate the effect of fluconazole antifungal prophylaxis on the severity of mucositis in head and neck cancer patients receiving radiotherapy . Patients and methods Sixty-three patients , with malignant head and neck tumor , eligible to receive radiotherapy , entered the study . Thirty-four patients ( group A ) received 100 mg/day of fluconazole prophylaxis during radiotherapy and were compared with 29 patients , who received radiotherapy alone ( group B ) . The two groups were similar in terms of patients and radiotherapy characteristics . Smear to test for C and ida carriage was taken before and after radiotherapy . Oral c and idiasis was diagnosed using the criteria described before . Oral mucositis was recorded according to EORTC/RTOG criteria .Main results A significant reduction of severe mucositis at the end of radiotherapy ( 14.7 vs 44.8 % , p=0.018 ) and of interruptions ( 0 vs 17.2 % , p=0.017 ) was observed in group A. C and idiasis was prevented ( 0 vs 34.5 % , p=0.001 ) , with a significant reduction of C and ida carriage of 40.7 % ( p=0.001 ) . Conclusion Fluconazole prophylaxis showed a significant beneficial impact on the severity of mucositis and on radiotherapy interruptions in this group of patients . The current study provides data on the build of a r and omized controlled trial on the effect of fluconazole prophylaxis on treatment schedule and quality of life of the patients during head and neck radiotherapy The aim of this study was to investigate oral yeast colonization and oral yeast strain diversity in irradiated ( head and neck ) , dentate , xerostomic individuals . Subjects were recruited from a nasopharyngeal carcinoma clinic and were segregated into group A ( age , < 60 years [ n = 25 ; average age + /- st and ard deviation ( SD ) , 48 + /- 6 years ; average postirradiation time + /- SD , 5 + /- 5 years ] ) and group B ( age , > /=60 years [ n = 8 ; average age + /- SD , 67 + /- 4 years ; average postirradiation time + /- SD , 2 + /- 2 years ] ) and were compared with age- and sex-matched healthy individuals in group C ( age , < 60 years [ n = 20 ; average age + /- SD , 44 + /- 12 years ] and group D ( age , > /=60 years [ n = 10 ; average age , 70 + /- 3 years ] ) . Selective culture of oral rinse sample s was carried out to isolate , quantify , and speciate yeast recovery . All test subjects underwent a 3-month comprehensive oral and preventive care regimen plus topical antifungal therapy , if indicated . A total of 12 subjects from group A and 5 subjects from group B were recalled for re assessment of yeast colonization . Sequential ( pre- and posttherapy ) C and ida isolate pairs from patients were phenotypically ( all isolate pairs ; biotyping and resistotyping profiles ) and genotypically ( C and ida albicans isolate pairs only ; electrophoretic karyotyping by pulsed-field gel electrophoresis , restriction fragment length polymorphism [ RFLP ] , and r and omly amplified polymorphic DNA [ RAPD ] assays ) evaluated . All isolates were C and ida species . Irradiated individuals were found to have a significantly increased yeast carriage compared with the controls . The isolation rate of C and ida posttherapy remained unchanged . A total of 9 of the 12 subjects in group A and 3 of the 5 subjects in group B harbored the same C. albicans or C and ida tropicalis phenotype at recall . Varying degrees of congruence in the molecular profiles were observed when these sequential isolate pairs of C. albicans were analyzed by RFLP and RAPD assays . Variations in the genotype were complementary to those in the phenotypic characteristics for some isolates . In conclusion , irradiation-induced xerostomia seems to favor intraoral colonization of C and ida species , particularly C. albicans , which appeared to undergo temporal modifications in clonal profiles both phenotypically and genotypically following hygienic and preventive oral care which included topical antifungal therapy , if indicated . We postulate that the observed ability of C and ida species to undergo genetic and phenotypic adaptation could strategically enhance its survival in the human oral cavity , particularly when salivary defenses are impaired Guidelines for the management of patients with invasive c and idiasis and mucosal c and idiasis were prepared by an Expert Panel of the Infectious Diseases Society of America . These up date d guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections . Since 2004 , several new antifungal agents have become available , and several new studies have been published relating to the treatment of c and idemia , other forms of invasive c and idiasis , and mucosal disease , including oropharyngeal and esophageal c and idiasis . There are also recent prospect i ve data on the prevention of invasive c and idiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive c and idiasis in adults . This new information is incorporated into this revised document To evaluate the efficacy of itraconazole capsules in prophylaxis for fungal infections in neutropenic patients , we conducted a prospect i ve , double-blind , placebo-controlled , r and omized trial . Patients with hematologic malignancies or those who received autologous bone marrow transplants were assigned either a regimen of itraconazole ( 100 mg orally twice daily ; n=104 ) or of placebo ( n=106 ) . Overall , fungal infections ( superficial or systemic ) occurred more frequently in the placebo group ( 15 % vs. 6 % ; P=.03 ) . There were no differences in the empirical use of amphotericin B or systemic fungal infections . Among patients with neutropenia that was profound ( < 100 neutrophils/mm3 ) and prolonged ( for at least 7 days ) , those receiving itraconazole used less empirical amphotericin B ( 22 % vs. 61 % ; P=.0001 ) and developed fewer systemic fungal infections ( 6 % vs. 19 % ; P=.04 ) . For patients with profound and prolonged neutropenia , itraconazole capsules at the dosage of 100 mg every 12 h reduce the frequency of systemic fungal infections and the use of empirical amphotericin Fungal infections are a major problem in patients with hematologic malignancy . Attempts to reduce their frequency with antifungal agents have not been successful . A double-blind , controlled , single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy . Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions . End points were  amphotericin B use , fungal infection , stable neutrophil count > 0.5 x 10(9)/L , toxicity precluding further fluconazole use , and death . By Kaplan-Meier estimation , the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole ( P = .003 ) . Also , fluconazole reduced the number of febrile days by 20 % ( P = .002 ) and prevented oropharyngeal c and idiasis ( 1/75 vs. 9/76 , P = .018 ) . The frequency of deep mycoses ( 8/76 vs. 8/75 ) and outcome were unaffected . Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia ( P = .01 ) 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 PURPOSE To identify predictors of oral mucositis and gastrointestinal toxicity after high-dose therapy . PATIENTS AND METHODS Mucositis and gastrointestinal toxicity were prospect ively evaluated in 202 recipients of high-dose therapy and autologous or allogeneic stem-cell rescue .  Of 10 outcome variables , three were selected as end points : the peak value for the University of Nebraska Oral Assessment Score ( MUCPEAK ) , the duration of parenteral nutritional support , and the peak daily output of diarrhea . Potential covariates included patient age , sex , diagnosis , treatment protocol , transplantation type , stem-cell source , and rate of neutrophil recovery . The three selected end points were also examined for correlation with blood infections and transplant-related mortality . RESULTS A diagnosis of leukemia , use of total body irradiation , allogeneic transplantation , and delayed neutrophil recovery were associated with increased oral mucositis and longer parenteral nutritional support . No factors were associated with diarrhea . Also , moderate to severe oral mucositis ( MUCPEAK > or = 18 on a scale of 8 to 24 ) was correlated with blood infections and transplant-related mortality : 60 % of patients with MUCPEAK > or = 18 had positive blood cultures versus 30 % of patients with MUCPEAK less than 18 ( P = .001 ) ; 24 % of patients with MUCPEAK > or = 8 died during the transplantation procedure versus 4 % of patients with MUCPEAK less than 18 ( P = .001 ) . CONCLUSION Gastrointestinal toxicity is a major cause of transplant-related morbidity and mortality , emphasizing the need for corrective strategies . The peak oral mucositis score and the duration of parenteral nutritional support are useful indices of gastrointestinal toxicity because these end points are correlated with clinical ly significant events , including blood infections and treatment-related mortality 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 
    Output:
    
Conclusions There is an increased risk of clinical ly significant oral fungal infection during cancer therapy .
Systemic antifungals are effective in the prevention of clinical oral fungal infection in patients receiving cancer therapy .