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Prevention of fungal infections in cancer patients with amphotericin B or fluconazole

Cancer patients treated with chemotherapy or who receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life‐threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever. The review could not detect a difference in effect between amphotericin B and fluconazole but several of the trials were designed or analysed in a way that disfavoured amphotericin B, which is the only antifungal drug that has been shown to have an effect on mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prevention of fungal infections in patients with cancer with amphotericin B

Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life‐threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever. The review found that lipid formulations of amphotericin B had fewer adverse effects (less nephrotoxicity and fewer dropouts) than conventional amphotericin B. However, it is not clear whether there are any advantages of these formulations if conventional amphotericin B is administered under optimal circumstances.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Is voriconazole better than amphotericin B or fluconazole to prevent and treat fungal infections in cancer patients with poor immune defence systems

Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of fungal infections. Such infections can be life‐threatening. Antifungal drugs are therefore often given to prevent fungal infections in such patients, either when these patients are known to have a fungal infection or when such an infection is suspected. We reviewed the evidence about the effect of voriconazole compared to amphotericin B or fluconazole to prevent or treat fungal infections in cancer patients with a poor immune system to provide defence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Which amphotericin B formulation better preserves kidney function among people with fungal infection?

Fungal infections can cause ill health, and in some cases, death. Conventional amphotericin B has been used for many years to treat fungal infection. Although effective, this drug can cause kidney damage in about eight of every ten patients treated. People with kidney damage have longer stays in hospital, increased healthcare costs, and higher numbers of deaths.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Prevention and treatment of fungal infections with nystatin in severely immunodepressed patients

People on chemotherapy for cancer, receiving a transplant or with AIDS are at risk of fungal infections. These infections can be life‐threatening, especially when they spread throughout the body. Nystatin is sometimes given as a routine preventive measure or as treatment in these patients. The review found that nystatin was no better than placebo (no treatment).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource‐limited settings

Despite the advent and increasingly wide availability of antiretroviral therapy for people with HIV/AIDS, cryptococcal meningitis remains a significant cause of death and illness amongst individuals with HIV infection in resource‐limited settings (poor countries). The ideal way to manage cryptococcal meningitis remains unclear. The main aim of this review was to determine the best treatment for cryptococcal meningitis in resource‐limited settings. In these settings, usually only Amphotericin and fluconazole are available. The authors didn't find any suitable studies that compared these two drugs. Because Flucytosine, which works well with Amphotericin, is often not available in poor countries, policy makers and government officials should consider using this drug for HIV treatment programmes. Future research into the management of cryptococcal meningitis in resource‐limited settings should focus on the most effective use of medications that are available in these settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Antifungal agents for infants and children with invasive fungal infections

Invasive fungal infections are a significant problem for children whose immune system is not functioning properly. The majority of the children have cancer. Antifungal medications can be given when these children develop a fever (for example a fever occurring when the white cells or neutrophils are low during chemotherapy) or when an infection has been formally identified (as in candidaemia, candidiasis and invasive aspergillosis). The antifungal agents that were compared appear equally efficacious. Pooling the data from the few studies that were available suggest kidney damage was less likely with a lipid preparation of amphotericin B compared with conventional amphotericin B. It is reasonable to recommend a lipid preparation of amphotericin B, if cost permits. No significant differences have been observed in children when other antifungal agents have been compared. More studies in children evaluating available antifungal are required to further clarify any benefits with regard to the risk of dying, prospects of complete recovery and drug toxicities.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Systemic antifungal drugs for invasive fungal infection in preterm infants

Preterm and sick newborn infants are at risk of serious infections of the blood, brain and kidneys due to fungi such as Candida (the organism that causes thrush). Severe fungal infections are associated with high death rates and with long‐term brain damage in newborn infants. A variety of different types of drugs for treating fungal infections are available. However, this systematic review found only very limited evidence (one small trial) to support the use of one type of antifungal drug over another. Until this uncertainty is resolved with new large trials, clinicians may continue to base their choice of antifungal agent on data extrapolated from studies in older children and adults.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antifungal agents for preventing fungal infections in critically ill adults and children with a normal number of neutrophils in the blood

We reviewed the evidence about the effect of giving antifungal medications before a definitive diagnosis of fungal infections on mortality from all causes and development of severe infections due to fungi (invasive fungal infections) in adults and children who are critically ill but non‐neutropenic, i.e. with a normal number of neutrophils in their blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Prevention of fungal infections in patients with cancer with antifungal drugs

Cancer patients receiving chemotherapy or a bone marrow transplant are at risk of fungal infections. These can be life‐threatening, especially when they spread throughout the body. Those patients with low white cell counts (neutropenia) are particularly at risk. Antifungal drugs are often given as a routine preventive measure, or when people who are at risk have a fever. The review found that intravenous amphotericin B could reduce the number of deaths. Three of the drugs, amphotericin B, fluconazole and itraconazole, reduced fungal infections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Medical treatments for fungal infection of the cornea (clear front part of the eye)

We identified 12 randomised controlled trials that included 981 people; the evidence is current up to March 2015. The trials were mainly conducted in India.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antifungal drugs used for prevention can significantly reduce the number of invasive fungal infections in liver transplant patients

Invasive fungal infections ‐ infections of the bloodstream and organs within the body (e.g. meningitis, pneumonia, peritonitis) ‐ are important causes of morbidity and mortality in liver, pancreas, heart, kidney and lung (i.e. solid organ) transplant recipients. This review found that fluconazole, used as a preventive drug, significantly reduced the number of invasive fungal infections in liver transplant patients. More studies are needed to determine how effective antifungal drugs are for pancreas, heart, kidney and lung transplant patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Treatments to fight fungal infections which cause allergic bronchopulmonary aspergillosis in people with cystic fibrosis

We planned to review evidence about the effect of treatments to fight fungal infections which cause allergic bronchopulmonary aspergillosis in people with cystic fibrosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for the prevention and management of oral thrush associated with HIV infection in adults and children

Oral candidiasis (thrush) associated with human immunodeficiency virus (HIV) infection occurs commonly and recurs frequently, often presenting as an initial manifestation of the disease. Interventions aimed at preventing and treating HIV‐associated oral thrush form an integral component of maintaining the quality of life for affected individuals. This review evaluated the effects of interventions in preventing or treating oral thrush in children and adults with HIV infection. Thirty three trials (n=3445) were included. Twenty two trials investigated treatment and eleven trials investigate prevention. There was no difference with regard to clinical cure between fluconazole compared to ketoconazole, itraconazole, clotrimazole and posaconazole. Fluconazole, gentian violet and ketoconazole were superior to nystatin. Compared to placebo and no treatment, fluconazole was effective in preventing clinical episodes from occurring. Continuous fluconazole was better than intermittent treatment. Insufficient evidence was found to come to any conclusion about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole, ketoconazole or chlorhexidine with regard to OC prophylaxis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for American cutaneous and mucocutaneous leishmaniasis.

American cutaneous and mucocutaneous leishmaniasis, a disfiguring and stigmatising disease affecting Central and South American regions, is caused by a parasite transmitted by sandflies. Pentavalent antimonial drugs (sodium stibogluconate (Pentostam, Stibanate, SSG) and meglumine antimoniate (Glucantime, MA)) have been used since the 1940s as first‐line therapeutic agents for cutaneous leishmaniasis worldwide. However, other treatments have been used because these are expensive, toxic and painful, and because resistance is emerging.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Treatment‐related early and late side effects on the kidney in survivors of childhood cancer

Over the past few decades, great improvements in diagnostics and treatment have resulted in a major increase in survival rates of childhood cancer. However, childhood cancer survivors (CCS) are at great risk of developing adverse effects as a result of their cancer treatment. One of the potential adverse effects of childhood cancer treatment is kidney damage. Renal adverse effects are common during and just after treatment, but very little evidence is available on the frequency of renal function impairment in long‐term CCS and on what the risk factors are. Survivors with impaired renal function due to childhood cancer treatment are usually symptom free. The kidneys are remarkably well able to compensate for problems in their functioning. However, when renal late adverse events become symptomatic, survivors can experience a range of symptoms, depending on the kidney functions that are damaged. This systematic review aimed to assess the magnitude of asymptomatic and symptomatic early and late renal adverse events in long‐term CCS and to identify which risk factors contribute to impaired renal function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Depression (PDQ®): Patient Version

Expert-reviewed information summary about the diagnosis, assessment, and treatment of depression in adults and children who have cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 30, 2016

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