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Preventing fungal infection during acute leukaemia treatment | CION Cancer Clinics
Antifungal medicine is given in acute leukaemia to stop a serious fungal infection before it starts. Intensive treatment can keep the white cell count very low for a long time, and that is when moulds and yeasts can invade the lungs or sinuses. Posaconazole, fluconazole and similar medicines lower that chance. Your haematologist decides whether it is needed, which one, and when it stops. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why is someone with leukaemia given antifungal medicine before any infection?
- Which antifungal medicines might be on the chart?
- What does taking it actually involve?
- Which other medicines can it clash with?
- What do families get wrong about antifungal prevention?
- What side effects are possible, and what can this page not tell you?
- Common questions about antifungal medicine in leukaemia
The short answer
Why is someone with leukaemia given antifungal medicine before any infection?
It is given to stop a serious fungal infection before it starts. Intensive treatment for acute leukaemia can leave the white cell count very low for a long stretch, and during that time moulds and yeasts that are harmless to most people can invade the lungs, sinuses or blood.
Why fungi, and why now
Fungal spores are in ordinary air, dust, soil, building work and damp walls. A healthy immune system clears them without you noticing. When the neutrophils, the white cells that fight these infections, stay low for many days, the spores get a chance to grow. These infections can be hard to spot early and hard to treat once they take hold, so preventing them is often the safer plan.
Who is usually offered it
It is most often used during induction, the first intensive block of treatment for acute myeloid leukaemia, and in other settings where counts are expected to stay very low for a long time. It is also used around stem cell transplant. Not everyone with leukaemia needs it. Someone on gentler treatment, with counts that recover quickly, may not be offered it at all.
Your haematologist decides whether it is needed, which medicine, and for how long. Never start, stop or skip it on your own.The medicines
Which antifungal medicines might be on the chart?
The generic name is what matters. The choice depends on the leukaemia, the other medicines being given, the liver and the heart.
Posaconazole
A tablet often chosen during intensive treatment for acute myeloid leukaemia, because it covers moulds as well as yeasts. It is usually taken with food.
May not suit
- People on medicines it strongly clashes with
- Some people with heart rhythm problems
Fluconazole
An older tablet that works well against yeasts such as Candida but not against moulds. It may be used where the mould risk is judged to be lower.
Voriconazole and itraconazole
Other tablets in the same family. Voriconazole can cause short-lived changes in vision and makes the skin burn easily in sunlight. The level in the blood sometimes needs checking.
Drip medicines
Micafungin or amphotericin may be given through a vein when tablets cannot be swallowed or absorbed, or when a tablet clashes with the leukaemia treatment.
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What does taking it actually involve?
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Starting
It usually begins around the start of intensive treatment, before the counts fall. The team checks liver tests, kidney tests and sometimes a heart tracing, called an ECG, first.
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Taking it the same way each time
Some of these tablets are absorbed far better with a meal. If eating is hard because of a sore mouth or vomiting, tell the nurse. The team may switch to a drip rather than let the level in the blood drop.
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Blood tests along the way
Liver tests are repeated because these medicines can strain the liver. For some medicines the team may also measure the drug level in the blood to check enough is getting in.
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Telling everyone about it
Any doctor, dentist or pharmacist who prescribes something new needs to know you are on an antifungal. Many common medicines clash with it.
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When it stops
It is usually stopped once the counts have recovered and the risk period is over. Your haematologist decides the day. Do not stop it because you feel well.
Medicine clashes
Which other medicines can it clash with?
If you are also on
Why the team needs to know
Vincristine, a common leukaemia drug
Some antifungals raise its effect on the nerves
Venetoclax or certain targeted tablets
The team may change their dose
Medicines for heart rhythm or some antibiotics
Together they can affect the heartbeat
Cholesterol tablets, sleeping tablets, antacids
Levels of either medicine can rise or fall
Herbal, Ayurvedic or home remedies
Effects are often unknown, so say what you take
Commonly believed
What do families get wrong about antifungal prevention?
"He has no infection, so this tablet is an extra we can skip."
The point is to take it while there is no infection. Missed doses let the level in the blood fall at exactly the time the white cells are lowest. If cost or side effects are a problem, tell the team rather than skipping.
"On an antifungal, a fever cannot be a fungal infection."
Prevention lowers the chance but does not remove it. Some fungi are not covered by every medicine. Any fever on low counts still needs the emergency department the same day.
"We can buy a cheaper antifungal from the local pharmacy."
These medicines are not interchangeable. Each covers different fungi and clashes with different leukaemia drugs. Swapping one for another, or for a different strength, can leave a gap in protection or raise side effects.
"Keeping the room shut and using a mask is enough."
Masks, clean rooms and staying away from building sites and damp help, but spores are still breathed in. The medicine and the precautions work together. Neither replaces the other.
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Signs that cannot wait, even on an antifungal
If there is a fever or shivering, a new cough, chest pain, breathlessness, coughing up blood, pain or swelling around the nose, eye or cheek, or a black crust inside the nose, go to the nearest emergency department now or call 108. Say the person has leukaemia, low counts and is on an antifungal. Take the medicine strip with you.
Being straight with you
What side effects are possible, and what can this page not tell you?
Most people take these medicines without serious trouble, but side effects do happen. Feeling sick, loose motions, headache and rash are the common ones. The team watches the liver tests and, for some medicines, the heartbeat. Voriconazole can blur or brighten vision for a short while and makes the skin sensitive to sunlight.
What it cannot promise
Prevention lowers the chance of a fungal infection. It does not make one impossible, and it does not replace hand washing, food safety and prompt care for a fever. This page cannot tell you whether your relative needs it, which medicine suits them, or how long they will take it.
Cost and access
Some of these medicines are expensive, and the course can run for weeks. Ask the team whether Aarogyasri, PM-JAY, CGHS, ECHS, EHS or your cashless insurance covers the medicine at your treating centre. Scheme rules change, so check the current position. If the cost is a worry, say so early. Stopping quietly is the riskiest choice.
How CION helps
CION's haematology team reviews the full treatment chart, discusses the case at a tumour board and coordinates care with qualified centres. We can go through the medicine list with you and help you prepare questions.
Questions we are asked
Common questions about antifungal medicine in leukaemia
Why is my father on an antifungal when he has no fungal infection?
Because his treatment is expected to keep his white cells very low for a long time, and that is when fungal infections take hold. Giving the medicine beforehand is meant to stop one starting. It does not mean the team has found an infection. Ask them how long they expect him to need it.
Can the tablet be taken on an empty stomach?
It depends on the medicine. Some are absorbed much better with a meal, and taking them without food can lower the amount in the blood. Follow the instructions on your prescription and ask the pharmacist if they are unclear. If eating is difficult, tell the team rather than guessing.
What if a dose is missed or vomited?
Call the ward or the haematology team for advice rather than doubling the next dose. They will tell you what to do for that medicine. If vomiting keeps happening, the tablet may not be getting in at all, and the team may switch to a drip for a while.
Will it damage the liver?
These medicines can raise liver test results, which is why blood tests are repeated during treatment. Most changes are mild and settle. If the tests rise a lot, the team may change the medicine. Tell them about yellow eyes, dark urine or pain under the right ribs.
Why does the doctor want an ECG while he is on it?
Some antifungals, especially alongside certain antibiotics or anti-sickness medicines, can affect the heart's rhythm. An ECG, a simple tracing of the heartbeat, checks this. Tell the team about palpitations, fainting or dizziness at once, and about any heart medicine he already takes.
Can we continue Ayurvedic or herbal medicines with it?
Tell the team about every one before continuing. Many herbal products change how the liver handles medicines, and their effects with antifungals and leukaemia drugs are often not known. Bring the packets or labels to the ward so the pharmacist can check what is in them.
Does taking it mean a fungal infection is impossible?
No. It lowers the chance but cannot remove it, because no single medicine covers every fungus. Any fever, new cough, chest pain or pain around the nose and eyes on low counts still needs the emergency department the same day. Do not wait to see whether it settles.
Is it covered by Aarogyasri or insurance?
It may be, when it is part of an approved leukaemia treatment plan. Coverage for costly medicines varies between Aarogyasri, PM-JAY, CGHS, ECHS, EHS and each insurer, and the rules change. Ask the billing desk at the treating centre to check your cover before the course begins.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Infection during cancer treatment
- American Cancer Society — Infections in people with cancer
- Cancer Research UK — Cancer drugs A to Z
- Macmillan Cancer Support — Treatments and drugs
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Invasive Fungal Infection: Recognising ItThe signs this medicine is meant to preventNeutropenic Fever: The Single Most Important EmergencyWhat to do the moment a fever starts on low countsPreventing PJP pneumonia with cotrimoxazoleThe other preventive medicine often given alongsideFood safety when white cells are lowEveryday precautions that work with the medicineLeukaemia guideThe wider picture of leukaemia and its treatment
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