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J Infect. 2007 Jun;54(6):521-9. Epub 2007 Jan 18.

Risk of resistance associated with fluconazole prophylaxis: systematic review.

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1
Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, USA. brionlp@aol.com <brionlp@aol.com>

Abstract

BACKGROUND:

Several studies have shown that fluconazole prophylaxis reduces the risk of fungal colonization and of invasive fungal infection in high-risk patients with minimal toxicity. This systematic review was designed to estimate the risk of emergence of colonization and infection either with azole susceptible-dose dependent or with resistant strains.

METHODS:

We searched Medline, EMBASE, the Cochrane Collaboration database and our own files for randomized controlled trials assessing the effect of fluconazole on the incidence of fluconazole-resistant strains.

RESULTS:

This systematic review of randomized clinical trials shows that fluconazole prophylaxis increases the risk for colonization with fluconazole susceptible-dose dependent or with resistant yeasts, the percentage of non-albicans Candida isolates and the percentage of fluconazole susceptible-dose dependent or resistant fungal isolates. Fluconazole prophylaxis did not significantly affect the risk of invasive disease with fluconazole susceptible-dose dependent or resistant fungi. The sample size was too small to assess the effect of fluconazole prophylaxis on the risk for breakthrough infections with non-albicans Candida.

CONCLUSION:

Evidence from randomized trials suggests that fluconazole prophylaxis increases the risk for colonization with fluconazole susceptible-dose dependent or with resistant fungi, but does not significantly affect the risk for invasive infections with fluconazole susceptible-dose dependent or with resistant fungi. The risk for breakthrough infections remains a concern and needs to be addressed in large prospective studies.

PMID:
17239952
DOI:
10.1016/j.jinf.2006.11.017
[Indexed for MEDLINE]
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