Treatment of Invasive Candidiasis in Neutropenic Patients: Systematic Review of Randomized Controlled Treatment Trials
Posted online on November 1, 2012. (doi:10.3109/10428194.2012.745073)
Jamil N. Kanji, Michel Laverdière, Coleman Rotstein, Thomas J. Walsh, Prakesh S. Shah and Shariq Haider
Corresponding Author: Shariq Haider, MD, FRCPC, Room M504, Juravinski Hospital and Cancer Center, 711 Concession Street, Hamilton, Ontario L8N 3Z5, Canada. Phone – (905) 521-2100, extension 43251. Fax – (905) 389-0108. Email: firstname.lastname@example.org
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 favoured 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 favour of non-polyene compounds. Across studies, echinocandins provided the benefit of favourable outcomes with fewest side effects and toxicity.
Candidiasis, invasive, amphotericin B, echinocandin, neutropenia