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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

Prophylactic oral/topical non‐absorbed antifungal agents to prevent invasive fungal infection in very low birth weight infants

Fungi such as candida (the organism that causes thrush) can cause severe infections in very low birth weight infants (birth weight < 1.5 kg). These infections are often difficult to diagnose and frequently cause death or disability. Therefore, it may be appropriate to attempt to prevent such infections by giving very low birth weight infants antifungal drugs as a routine part of their care. This review assessed specifically the effect of giving infants antifungal drugs that reduce skin and gut carriage of fungi to minimise the chances of a severe infection developing. The trials that were identified suggested that this treatment might reduce severe infection rates but there was no evidence that death rates were reduced. Larger and higher quality trials are needed to resolve this uncertainty.

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

Version: 2013

Topical treatment for vaginal candidiasis (thrush) in pregnancy

Imidazoles are best but pregnant women may need longer (7 not 4 day) courses. Thrush is a common vaginal infection in pregnancy causing itching and soreness. There is no evidence that this yeast infection harms the baby. Antifungal creams are effective. Imidazoles (such as clotrimazole) are more effective than older treatments such as nystatin and hydrargaphen. Longer courses (7 days) cured more than 90% of women whereas standard (4 day) courses only cured about half the cases.

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

Version: 2013

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

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 preventing oral candidiasis for patients with cancer receiving treatment

There is strong evidence that some antifungal drugs prevent oral candidiasis (thrush) caused by cancer treatment, but nystatin does not appear to work.

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

Version: 2009

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