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Evidence summaries

Preventing Oral Candidiasis in Cancer Patients

Antifungal drugs absorbed or partially absorbed from the gastrointestinal (GI) tract are effective in preventing oral candidiasis in patients receiving treatment for cancer compared to placebo. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 28 trials with a total of 4 226 subjects. Drugs absorbed (fluconazole, ketoconazole, itraconazole) and partially absorbed (miconazole, clotrimazole) from the GI tract were found to prevent oral candidiasis when compared to a placebo, or a no treatment control group (RR for absorbed drugs 0.47, 95% CI 0.29 to 0.78). For absorbed drugs in populations with an incidence of 20% (mid range of results in control groups), this implies a NNT of 9 (95% CI 7 to 13; number of patients needed to be treated to avoid one patient getting oral candidiasis). There was no significant benefit for drugs not absorbed from the GI tract.

A systematic review 2 including 9 RCTs with a total of 710 subjects was abstracted in DARE. The interventions included either systemic or topical antifungal agents (miconazole, amphotericin, ketoconazole, clotrimazole, fluconazole) versus placebo. The proportion of patients developing candidiasis was lower in the prophylaxis group in all selected trials (0.06 vs 0.44) with an odds ratio of 0.15 (95% CI 0.10 to 0.22). The summary odds ratio for colonisation status as a risk factor for oropharyngeal candidiasis was 3.66 (95% CI 1.74 to 5.18).

    References

    • Clarkson JE, Worthington HV, Eden OB. Interventions for preventing oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2007 Jan 24;(1):CD003807 [Review content assessed as up-to-date: 4 August 2009]. [PubMed]
    • Meunier F, Paesmans M, Autier P. Value of antifungal prophylaxis with antifungal drugs against oropharyngeal candidiasis in cancer patients. Eur J Cancer B Oral Oncol 1994 May;30B(3):196-9. [PubMed] [DARE]

Primary/Secondary Keywords