Routine versus selective antifungal administration for control of fungal infections in patients with cancer
Cochrane Database of Systematic ReviewsPublished 4 September 2014Open access
Peter C Gøtzsche, Helle Krogh Johansen
Citations64
SJR quartileQ1
SJR score1.62
SNIP2.04
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TL;DR
Intravenous amphotericin B was the only antifungal agent that reduced total mortality and should therefore be preferred when prophylactic or empirical antIFungal therapy is introduced in cancer patients with neutropenia.
Abstract
Intravenous amphotericin B was the only antifungal agent that reduced total mortality. It should therefore be preferred when prophylactic or empirical antifungal therapy is introduced in cancer patients with neutropenia.
Keywords
Medicine
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Itraconazole is a synthetic antifungal agent approved in the USA for the treatment of onychomycosis and serious systemic fungal infections and its label has been changed to alert physicians to this new finding.
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Ambisome 2 mg/kg three times weekly is safe and reduces fungal colonisation in patients receiving intensive chemotherapy or bmt, however, despite encouraging trends, prophylactic ambisome did not lead to a significant reduction in fungal infection or in requirement for systemic antifungal therapy.
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In AML patients undergoing induction chemotherapy, prophylactic oral voriconazole 200 mg twice daily resulted in trends towards reduced incidences of lung infiltrates and hepatosplenic candidiasis.
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87 Citations2000Michél Laverdière
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86 Citations1979Ediz Z. Ezdinli
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74 Citations2014Helle Krogh Johansen, Peter C Gøtzsche
It is not clear whether there are any advantages of lipid-based formulations if conventional amphotericin B is administered under optimal circumstances, and their high cost prohibits routine use in most settings.
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66 Citations2014Peter C Gøtzsche, Helle Krogh Johansen
Nystatin cannot be recommended for prophylaxis or the treatment of Candida infections in immunodepressed patients and was similar to that of placebo on fungal colonisation and mortality.
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Intravenous amphotericin B was the only antifungal agent that reduced total mortality and should therefore be preferred when prophylactic or empirical antIFungal therapy is introduced in cancer patients with neutropenia.
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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.
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48 Citations1987Richard M. Hansen
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46 Citations2012Desireé Caselli, Simone Cesaro +12 more
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