Treatment of Invasive Candidal Infections

[Guest guest]

From the current issue of Mayo Clinic Proceedings

(The complete article is available, online, for $10, or wait 6 months and it's

free)

 ANAT GAFTER-GVILI, MD; LIAT VIDAL, MD; ELAD GOLDBERG, MD;

LEONARD LEIBOVICI, MD; MICAL PAUL, MD 

Individual reprints of this article are not available. Address correspondence to

Anat Gafter-Gvili, MD, Department of Hematology, off Cancer Center, Rabin

Medical Center, Beilinson Campus, 49100 Petah-Tiqva, Israel

(anatga2@...).

 

OBJECTIVE: To compare available antifungal treatments for invasive candidiasis,

a leading cause of nosocomial bloodstream infections.

 

METHODS: We performed a systematic review and meta-analysis of randomized

controlled trials that compared different antifungal agents for the treatment of

candidemia and other forms of invasive candidiasis. Two reviewers independently

appraised the quality of trials and extracted data. The primary outcome was

all-cause mortality, and secondary outcomes were microbiological failure,

treatment failure, and adverse events. Relative risks (RRs) with 95% confidence

intervals (CIs) were pooled.

 

RESULTS: Of the 15 included trials, 9 compared fluconazole with other drugs

(amphotericin B, itraconazole, or a combination of fluconazole and amphotericin

, 4 compared echinocandins with other drugs (fluconazole, amphotericin B,

liposomal amphotericin , 1 compared micafungin and caspofungin, and 1 compared

amphotericin B plus fluconazole and voriconazole. No difference in mortality was

observed with fluconazole vs amphotericin B (RR, 0.92; 95% CI, 0.72-1.17);

however, the rate of microbiological failure increased in the fluconazole arm

(RR, 1.52; 95% CI, 1.12-2.07). Anidulafungin decreased the rate of

microbiological failure compared with fluconazole (RR, 0.50; 95% CI, 0.29-0.86)

with fewer adverse events. Caspofungin was comparable to amphotericin B in

mortality and efficacy, with fewer adverse events requiring discontinuation (RR,

0.11; 95% CI, 0.04-0.36). Micafungin was comparable to liposomal amphotericin B

in mortality.

 

CONCLUSION: All assessed antifungal agents showed similar efficacy, but the rate

of microbiological failure increased with fluconazole vs amphotericin B or

anidulafungin. Amphotericin B is associated with a higher rate of adverse events

than fluconazole and echinocandins.

 

Mayo Clin Proc. 2008;83(9):1011-1021

 

http://tinyurl.com/5e65v4