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Evidence summaries

Antifungal Prophylaxis in Non-Neutropenic Critically Ill Patients

Prophylaxis with fluconazole or ketoconazole in critically ill patients reduces invasive fungal infections by one half and total mortality by one quarter. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 12 studies (eight comparing fluconazole and four ketoconazole with no antifungal or a nonabsorbable agent) with a total of 1 606 subjects. Combined results of trials with fluconazole/ketoconazole prophylaxis showed a reduction in total mortality by about 25% (relative risk 0.76, 95% confidence interval 0.59 to 0.97) and invasive fungal infections by about 50% (RR 0.46, 95% CI 0.31 to 0.68). Results across all trials were homogeneous despite considerable heterogeneity in clinical and methodological characteristics.

    References

    • Playford EG, Webster AC, Sorrell TC, Craig JC. Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients. Cochrane Database Syst Rev 2006 Jan 25;(1):CD004920. [PubMed]

Primary/Secondary Keywords