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Evidence summaries

Routine Versus Selective Antifungal Administration for Control of Fungal Infections in Patients with Cancer

Intravenous amphotericin B may reduce mortality in cancer patients with neutropenia. Level of evidence: "C"

32 trials involving 4287 patients were included in a Cochrane review [Abstract] 1. Intravenous amphoterisin B reduced total mortality (relative risk 0.69, 95% CI 0.50 to 0.96) whereas the estimated RRs 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.

Comment: The quality of evidence is downgraded by imprecise results (few events) and by study quality.

References

  • Gøtzsche PC, Johansen HK. Routine versus selective antifungal administration for control of fungal infections in patients with cancer. Cochrane Database Syst Rev 2014;9():CD000026. [PubMed].

Primary/Secondary Keywords