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Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials

2012; Taylor & Francis; Volume: 54; Issue: 7 Linguagem: Inglês

10.3109/10428194.2012.745073

1042-8194

Jamil N. Kanji, Michél Laverdière, Coleman Rotstein, Thomas J. Walsh, Prakesh S. Shah, Shariq Haider,

Neutropenia and Cancer Infections

Candidemia and invasive candidiasis (CIC) is associated with considerable morbidity and mortality, with a paucity of controlled data in neutropenic patients. A systematic review was conducted of available data for the treatment of CIC during neutropenia. A structured OVID search of multiple databases was performed. Data from randomized controlled trials of CIC and of empirical antifungal therapy in febrile neutropenic patients was included. A total of 17 trials randomizing 342 neutropenic patients were included. Eight of the studies compared amphotericin B (AmB) to other non-polyene antifungal agents. Pooling of results favored use of comparator compounds (odds ratio [OR] 0.73; 95% confidence interval [CI] 0.42-1.29). To strengthen our analysis, a pre-planned sensitivity analysis was also conducted. Overall, there was a non-significant benefit in favor of non-polyene compounds. Across studies, echinocandins provided the benefit of favorable outcomes with fewest side effects and toxicity.