Patients receiving induction therapy for AML are at high risk for developing invasive fungal infections (IFIs). IFIs are significant as they are associated with substantial morbidity, delayed cancer treatment, increased health services utilization, and treatment-related mortality. Intensive chemotherapy destroys the mucosal barrier, leading to mucositis, colitis, or gastritis, which predisposes patients to systemic fungal propagation and/or fungemia. Early diagnosis and treatment improve patient's outcomes. However, establishing the diagnosis of systemic fungal infections is difficult as they do not manifest with specific symptoms or signs, blood cultures are often negative, and obtaining the tissue for histologic examination is difficult. Up to one-fourth of patients develop IFI during induction therapy of AML with an associated mortality of 40%-60%. Infections with Candida and Aspergillus species are most common. Systemic antifungal prophylaxis (AFP) is an effective approach to reducing the incidence of IFI. Comprehensive knowledge of antifungal agents, their activity, efficacy, and resistance patterns is required for designing effective AFP strategies. This review addresses the evidence on the prophylactic role of various available antifungal agents, their efficacy, and duration of therapy with a brief note on recommendations.
