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Leuk Lymphoma. 2013 Jul;54(7):1479-87. doi: 10.3109/10428194.2012.745073. Epub 2012 Dec 3.

Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials.

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Division of Infectious Diseases, Department of Medicine, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada.


Candidemia and invasive candidiasis (CIC) is associated with considerable morbidity and mortality, with a paucity of controlled data in neutropenic patients. A systematic review was conducted of available data for the treatment of CIC during neutropenia. A structured OVID search of multiple databases was performed. Data from randomized controlled trials of CIC and of empirical antifungal therapy in febrile neutropenic patients was included. A total of 17 trials randomizing 342 neutropenic patients were included. Eight of the studies compared amphotericin B (AmB) to other non-polyene antifungal agents. Pooling of results favored use of comparator compounds (odds ratio [OR] 0.73; 95% confidence interval [CI] 0.42-1.29). To strengthen our analysis, a pre-planned sensitivity analysis was also conducted. Overall, there was a non-significant benefit in favor of non-polyene compounds. Across studies, echinocandins provided the benefit of favorable outcomes with fewest side effects and toxicity.

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