Is preemptive antifungal therapy a good alternative to empirical treatment in prolonged febrile neutropenia?
Patients with prolonged febrile neutropenia are at high risk of invasive fungal infection, so it has been standard practice to initiate empirical antifungal therapy in these cases. However, this strategy is associated with important toxicity, so diagnostic test-guided preemptive antifungal therapy has been proposed as an alternative. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including twelve studies overall. Four randomized controlled trials addressed the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded it is not clear whether preemptive strategy affects mortality because the certainty of the evidence is very low, but it might slightly decrease the use of antifungal agents in patients with prolonged febrile neutropenia.
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile. Email: radagabriel@epistemonikos.org.
Erica
E
Koch
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile; Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; GRADE working group; The Cochrane Collaboration.
Gabriel
G
Rada
D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000150:complications*; D006801:Humans; D000072742:Invasive Fungal Infections / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013997:Time Factors
D000935:Antifungal Agents