Routine versus selective antifungal administration for control of fungal infections in patients with cancerreview
Аннотация: Background Systemic fungal infection is considered to be an important cause of morbidity and mortality in cancer patients, particularly those with neutropenia. Antifungal drugs are often given prophylactically, or empirically, to patients with persistent fever. Objectives To assess the effect of antifungal drugs in cancer patients with neutropenia. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 4, 2007, PubMed (November 2007) and the reference lists of articles. We searched the proceedings of the ICAAC (from 1990 to 2007), General Meeting of the ASM (from 1990 to 2007), and the European Congress of Clinical Microbiology and Infectious Diseases (1995 to 2007) and contacted researchers in the field. For the 2011 update we searched PubMed from 1966 to 18 July 2011 and the reference lists of articles. Selection criteria Randomised clinical trials of amphotericin B, fluconazole, ketoconazole, miconazole, itraconazole or voriconazole compared with placebo or no treatment in cancer patients with neutropenia. Data collection and analysis The two review authors independently assessed trial eligibility, risk of bias and abstracted data. Main results Thirty‐two trials involving 4287 patients were included. Prophylactic or empirical treatment with amphotericin B decreased total mortality significantly (relative risk (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.96), whereas the estimates for fluconazole, ketoconazole, miconazole, and itraconazole were close to 1.00. No eligible trials were found with voriconazole. Amphotericin B and fluconazole decreased mortality ascribed to fungal infection, RR 0.45 (95% CI 0.26 to 0.76) and RR 0.42 (95% CI 0.24 to 0.73), respectively. The incidence of invasive fungal infection decreased significantly with administration of amphotericin B (RR 0.41, 95% CI 0.24 to 0.73), fluconazole (RR 0.39, 95% CI 0.27 to 0.57) and itraconazole (RR 0.53, 95% CI 0.29 to 0.97), but not with ketoconazole or miconazole. Effect estimates were similar for those 13 trials that had adequate allocation concealment and were blinded. The reporting of harms was far too variable from trial to trial to allow a meaningful overview. For the 2011 update no additional trials were identified for inclusion. Authors' conclusions Intravenous amphotericin B was the only antifungal agent that reduced total mortality. It should therefore be preferred when prophylactic or empirical antifungal therapy in cancer patients with neutropenia is instituted.
Год издания: 2002
Авторы: Peter C Gøtzsche, Helle Krogh Johansen
Издательство: Cochrane
Источник: Cochrane database of systematic reviews
Ключевые слова: Antifungal resistance and susceptibility, Fungal Infections and Studies, Neutropenia and Cancer Infections
Другие ссылки: Cochrane database of systematic reviews (HTML)
PubMed (HTML)
PubMed (HTML)
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