title: Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Jamil N
authors.initials: JN
authors.lastname: Kanji
authors.forename: Michel
authors.initials: M
authors.lastname: Laverdière
authors.forename: Coleman
authors.initials: C
authors.lastname: Rotstein
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.forename: Shariq
authors.initials: S
authors.lastname: Haider
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D058365:Candidiasis, Invasive / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D054714:Echinocandins / Q000627:therapeutic use; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000666:Amphotericin B