Amphotericin B versus fluconazole for controlling fungal infections in neutropenic cancer patients
Cochrane Database of Systematic ReviewsPublished 22 April 2002
Helle Krogh Johansen, Peter C Gøtzsche
Citations30
SJR quartileQ1
SJR score1.62
SNIP2.04
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TL;DR
Since intravenous amphotericin B is the only antifungal agent for which there is good evidence suggesting an effect on mortality and is considerably cheaper than fluconazole, it should be preferred.
Abstract
Amphotericin B had been disfavoured in most of the trials through their design or analysis. Since intravenous amphotericin B is the only antifungal agent with a documented effect on mortality and is considerably cheaper than fluconazole, it should be preferred.
Keywords
Medicine
New England Journal of MedicineA Controlled Trial of Fluconazole to Prevent Fungal Infections in Patients Undergoing Bone Marrow Transplantation
1,177 Citations1992Jesse L. Goodman, Drew J. Winston +19 more
Prophylactic administration of fluconazole to recipients of bone marrow transplants reduces the incidence of both systemic and superficial fungal infections.
BMJPublication bias: evidence of delayed publication in a cohort study of clinical research projects
829 Citations1997Jerome M Stern, R. J. Simes
The Journal of Infectious DiseasesEfficacy and Safety of Fluconazole Prophylaxis for Fungal Infections after Marrow Transplantation--A Prospective, Randomized, Double-Blind Study
827 Citations1995Monica A. Slavin, BE Osborne +6 more
Prophylactic fluconazole was safe and significantly reduced systemic fungal infections with other benefits, including improved survival at day 110 after marrow transplantation.
BMJSelective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.
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Routine use of selective serotonin reuptake inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit, according to meta-analysis of 63 randomised controlled trials.
Clinical Infectious DiseasesManagement of Invasive Candidal Infections: Results of a Prospective, Randomized, Multicenter Study of Fluconazole Versus Amphotericin B and Review of the Literature
275 Citations1996E. J. Anaissie, Rabih O. Darouiche +8 more
It is confirmed that fluconazole is as effective as but better tolerated than amphotericin B in the treatment of candidal infections.
CancerAntifungal prophylaxis for severely neutropenic chemotherapy recipients
260 Citations2002Eric J. Bow, Michél Laverdière +4 more
The overall clinical efficacy of the azoles antifungal agents and low‐dose intravenous amphotericin B for antifundal chemoprophylaxis in patients with malignant disease who have severe neutropenia remains unclear.
BMJComparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial
234 Citations2001Urs Eriksson, Burkhard Seifert +1 more
Testing the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion found it to reduce nephrotoxicity and side effects related to infusion without increasing mortality.
The American Journal of MedicineA multicenter, randomized trial of fluconazole versus amphotericin B for empiric antifungal therapy of febrile neutropenic patients with cancer
189 Citations2000Drew J. Winston, James W. Hathorn +3 more
Intravenous fluconazole can be an effective and safe alternative to amphotericin B for empiric antifungal therapy in many febrile neutropenic patients, however, patients at risk for that infection should be evaluated by chest radiograph, computed tomographic scanning, and cultures before the use of empiric fluConazole therapy.
BMJMeta-analysis: Unresolved issues and future developments
176 Citations1998George Davey Smith, Matthias Egger
In this final article of the series, some of the topics that are likely to feature in future discussions of the appropriate practice and domain of meta-analysis are addressed.
Annals of Internal MedicinePreventing Fungal Infection in Neutropenic Patients with Acute Leukemia: Fluconazole Compared with Oral Amphotericin B
141 Citations1994Francesco Menichetti, Albano Del Favero +12 more
The role of systemic and topical antifungal prophylactic agents in neutropenic patients with acute leukemia is clarified by doing a large, randomized, multicenter trial that compared the efficacy and tolerability of oral fluconazole with high-dose amphotericin B suspension.
CancerAntifungal prophylaxis during remission induction therapy for acute leukemia fluconazole versus intravenous amphotericin B
132 Citations1994Gerald P. Bodey, Elias Anaissie +4 more
Fluconazole (FLU) is a new anti‐fungal agent that has been used successfully to treat Candida infections and has modest activity against aspergillosis in animal models and amphotericin B (AMB) has been considered effective as prophylaxis in patients undergoing remission induction therapy for acute leukemia.
PubMedCandida infections in bone marrow transplant recipients.
129 Citations1991Catherine M. Verfaillie, Daniel J. Weisdorf +4 more
Systemic Candida infection was detected in 76 patients (12.5%) in the first year following BMT and 60/76 patients with Candida infections have died, and in 19/60 cases death could be directly attributed toCandida infection.
JAMAProblems in the Design and Reporting of Trials of Antifungal Agents Encountered During Meta-analysis
127 Citations1999Helle Krogh Johansen
The unanticipated problems the authors encountered in collecting data for a meta-analysis comparing a new antifungal agent, fluconazole, with amphotericin B in patients with cancer complicated by neutropenia are described.
European Journal of CancerFactors associated with bacteraemia in febrile, granulocytopenic cancer patients
124 Citations1994Claudio Viscoli, Paolo Bruzzi +9 more
European Journal of CancerFluconazole versus amphotericin B as empirical antifungal therapy of unexplained fever in granulocytopenic cancer patients: a pragmatic, multicentre, prospective and randomised clinical trial
122 Citations1996Claudio Viscoli, Elio Castagnola +9 more
Fluconazole is shown to be by far less toxic than amphotericin B and suggests that it might be as effective as amphotericIn B, in pragmatical terms and for this specific indication, however, numbers are too small to allow definitive conclusions about efficacy, and the use of fluconazoles for this indication remains experimental.
Bone Marrow TransplantationFluconazole vs low-dose amphotericin B for the prevention of fungal infections in patients undergoing bone marrow transplantation: a study of the North American Marrow Transplant Group
117 Citations2000SN Wolff, Joseph W. Fay +14 more
In this prospective trial, low-dose amphotericin B prophylaxis was as effective as Fluconazole prophYLaxis, but Flu Conazole was significantly better tolerated and overall survival to hospital discharge.
Journal of Antimicrobial ChemotherapyRandomized comparison of oral fluconazole versus oral polyenes for the prevention of fungal infection in patients at risk of neutropenia
116 Citations1993John Philpott‐Howard, Jim Wade +3 more
Once-a-day fluconazole was therefore more effective than oral polyenes for the Prevention of oropharyngeal fungal infection and as effective for the prevention of infections at other sites in patients with neutropenia.
European Journal of Clinical Microbiology & Infectious DiseasesA multicentre study of fluconazole versus oral polyenes in the prevention of fungal infection in children with hematological or oncological malignancies
108 Citations1994J. Ninane
Fluconazole given once daily may be more effective than and as safe as oral nystatin or amphotericin B given four times daily in the prevention of fungal infection in children with malignancies necessitating chemotherapy or radiotherapy.
BMJMeta-analysis of prophylactic or empirical antifungal treatment versus placebo or no treatment in patients with cancer complicated by neutropenia
107 Citations1997P. C Gotzsche, H. Johansen
The American Journal of MedicineA randomized comparison of fluconazole with amphotericin B as empiric anti-fungal agents in cancer patients with prolonged fever and neutropenia
106 Citations1998Imtiaz A. Malik, Imran Moid +3 more
It is suggested that fluconazole is an equally effective but less toxic alternative to amphotericin B as empiric antifungal therapy in cancer patients with prolonged fever and neutropenia.
BMJStudy of information submitted by drug companies to licensing authorities.
97 Citations1980Elina Hemminki
This study provides support for those who want to see public disclosure of the reports of trials submitted in licensing applications by drug companies to licensing authorities in Finland and Sweden in four different years.
MedicineEFFECT OF PROPHYLACTIC MEASURES ON THE MICROBIAL FLORA OF PATIENTS IN PROTECTED ENVIRONMENT UNITS
88 Citations1974Gerald P. Bodey, B Rosenbaum
Journal of Antimicrobial ChemotherapyA randomized study to compare oral fluconazole to amphotericin B in the prevention of fungal infections in patients with acute leukaemia
79 Citations1991M. Rozenberg-Arska, A W Dekker +2 more
Antimicrobial Agents and ChemotherapyDouble-blind randomized study of the effect of infusion rates on toxicity of amphotericin B
75 Citations1992Michael Ellis, Abdullah Alhokail +6 more
A rapid infusion regimen for amphotericin B cannot be recommended, at least during the first 5 to 7 days of treatment, and by day 7 the incidence and severity were the same.
Bone Marrow TransplantationAmphotericin B colloidal dispersion (Amphocil) vs fluconazole for the prevention of fungal infections in neutropenic patients: data of a prematurely stopped clinical trial
68 Citations2000G.J. Timmers, Sonja Zweegman +4 more
It is concluded that ABCD is not suitable for antifungal prophylaxis in neutropenic patients due to severe infusion-related side-effects, and subject numbers were too low for conclusions on variables of antIFungal efficacy.
American Journal of HematologyRandomized trial of fluconazole versus low‐dose amphotericin B in prophylaxis against fungal infections in patients undergoing hematopoietic stem cell transplantation
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It is concluded that fluconazole is as effective as low‐dose amphotericin B in prophylaxis against fungal infections in patients undergoing hematopoietic cell transplantation.
Antimicrobial Agents and ChemotherapyAmphotericin B in Children with Malignant Disease: a Comparison of the Toxicities and Pharmacokinetics of Amphotericin B Administered in Dextrose versus Lipid Emulsion
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It was shown that there were significant increases in plasma urea and creatinine concentrations and in potassium requirement after 6 days of therapy with both AmB infused in dextrose and AmB infusion in lipid emulsion, with there being no difference between the two methods of AmB administration.
Cochrane Database of Systematic ReviewsRoutine versus selective antifungal administration for control of fungal infections in patients with cancer
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Routine prophylactic or later therapy with antifungal drugs in cancer patients with neutropenia does not appear to have a beneficial effect on mortality and only a modest effect on fungal invasion.
Journal of Antimicrobial ChemotherapyFluconazole versus nystatin in the prevention of candida infections in children and adolescents undergoing remission induction or consolidation chemotherapy for cancer
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Fluconazole was as safe and effective as nystatin in controlling yeast colonization and in preventing superficial and invasive candida infections and the empirical use of amphotericin B in children and adolescents undergoing intensive chemotherapy for cancer.
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Amphotericin B has been disfavoured in several of the trials through their design or analysis, or both, and since it is considerably cheaper than fluconazole, it should be the preferred agent.
Hämatologie und BluttransfusionManagement of Fungal Infection in Neutropenic Patients with Fluconazole
40 Citations1990K. W. Brammer
Cochrane Database of Systematic ReviewsNystatin prophylaxis and treatment in severely immunodepressed patients
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ChemotherapyFluconazole versus Amphotericin B in the Treatment of Esophageal Candidiasis in Cancer Patients
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The efficacy of oral fluconazole in esophageal candidiasis appears to be equivalent to that of amphotericin, with fewer adverse reactions.
Clinical Drug InvestigationChemoprophylaxis of Fungal Infections in Granulocytopenic Patients Using Fluconazole vs Oral Amphotericin B
33 Citations1991Frédéric A. Meunier, Mabel Aoun +3 more
The respective roles of oral amphotericin B and fluconazole in granulocytopenic cancer patients and the overall mortality was similar in each group, but the median duration of prophylaxis prior to the first fever episode was longer in patients receiving flu Conazole than in those receiving amphoteric in B.
MycosesEarly empiric antifungal therapy of infections in neutropenic patients comparing fluconazole with amphotericin B/flucytosine
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Fluconazole may be preferred as first line empiric antifungal agent, but in case of nonresponse, pneumonia or aspergillosis it may be replaced by amphotericin B combined with flucytosine.
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Since intravenous amphotericin B is the only antifungal agent for which there is good evidence suggesting an effect on mortality and is considerably cheaper than fluconazole, it should be preferred.
MycosesFluconazole versus oral amphotericin B in preventing fungal infection in chemotherapy‐induced neutropenic patients with haematological malignancies Vergleichende Studie über
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No difference was observed in the efficacy of fluconazole in comparison with oral amphotericin B in preventing clinically suspected fungal infection in patients with haematological malignancies.
Supportive Care in CancerMust we really fear toxicity of conventional amphotericin B in oncological patients?
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Sufficient hydration of patients and ion supplementation corresponding to the amount lost by the kidneys is an effective prophylaxis for prevention of AmB-induced decrease in renal function and for countering imbalances of serum electrolyte concentrations during use of Amb.
Journal of InfectionSystemic amphotericin B versus fluconazole in the management of antibiotic resistant neutropenic fever — preliminary observations from a pilot, exploratory study
22 Citations1995Michael E. Ellis, Magid A. Halim +6 more
Analysis of a small subgroup of patients who had all received prior prophylaxis with clotrimazole only, indicated that a greater number of patients subsequently receiving IV FLUC died from fungal disease.
Journal of Antimicrobial ChemotherapyAntifungal drug susceptibility testing: Working Party of the British Society for Antimicrobial Chemotherapy
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The current situation with regard to intrinsic and acquired resistance to antifungal compounds and progress with the development of standardized methods of susceptibility testing for amphotericin B, flucytosine, and the azoles is described.
BMC Medical Research MethodologyFungal infection-related mortality versus total mortality as an outcome in trials of antifungal agents
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Fluconazole may be preferred as first line empiric antifungal agent, but in case of nonresponse, pneumonia or aspergillosis it may be replaced by amphotericin B combined with flucytosine.