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Caspofungin for prophylaxis and treatment of fungal infections in adolescents and adults: a meta-analysis of randomized controlled trials

BACKGROUND AND OBJECTIVE: Caspofungin, a novel echinocandin compound, has been approved for the treatment of esophageal and suspected invasive candidiasis and as salvage therapy for invasive aspergillosis. The aim of this study was to assess the efficacy and safety of caspofungin for the prophylaxis and treatment of fungal infections, compared with other medications.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Caspofungin versus liposomal amphotericin B for treatment of invasive fungal infections or febrile neutropenia

BACKGROUND: Nowadays, there are published trials in regards to the comparison of caspofungin with liposomal amphotericin B (L-AmB). However, these studies have a modest sample size and convey inconclusive results. The aim of this study was to review the efficacy and safety of caspofungin for the treatment of invasive fungal infections (IFIs), compared with L-AmB.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials

This review evaluated the effectiveness and safety of caspofungin in the treatment of patients with fungal, mainly Candida, infections. The authors concluded that caspofungin is associated with a higher cure rate and fewer adverse effects in comparison with amphotericin B. These conclusions have to be viewed with caution since they are based on few studies with few participants.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

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: 2017

Acute Kidney Injury: Prevention, Detection and Management Up to the Point of Renal Replacement Therapy [Internet]

Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2013
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Posaconazole for the Treatment or Prophylaxis of Aspergillosis or Candidiasis: A Review of Clinical Effectiveness and Guidelines [Internet]

The purpose of this Rapid Response report is to review the clinical effectiveness and evidence-based guidelines regarding the use of posaconazole for the treatment or prophylaxis of aspergillosis or candidiasis.

Rapid Response Report: Summery With Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 27, 2016
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Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of childhood acute myeloid leukemia, myelodysplastic syndromes, and other myeloproliferative disorders.

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

Version: April 4, 2017

Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients

Guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances - and these can include prevention and self-care through to primary and secondary care and on to more specialised services. NICE clinical guidelines are based on the best available evidence of clinical and cost effectiveness, and are produced to help healthcare professionals and patients make informed choices about appropriate healthcare. While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: September 2012
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Newer antifungal agents for fungal infection prevention during hematopoietic cell transplantation: a meta-analysis

OBJECTIVE: The efficacy of newer antifungal agents to provide effective prophylaxis during stem cell transplantation has not yet been established. We compared the clinical outcomes using of the newer triazoles and echinocandins for antifungal prophylaxis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Systematic review and mixed treatment comparison of randomized evidence for empirical, pre-emptive and directed treatment strategies for invasive mould disease

Randomized controlled trials (RCTs) provide the most reliable estimates of the effects of treatments. However, not all treatments are compared in available RCTs, making comparison of treatments problematic. Mixed treatment comparisons (MTCs) can provide estimates of the comparative effects of treatments across a range of available therapeutic options. MTCs use networks of available direct comparisons to estimate differences in treatments that have not been estimated in trials via a common comparator. We conducted a systematic review and MTCs of comparative RCTs in haematological patients of anti-mould active agents used for the empirical treatment of febrile neutropenia (Analysis 1), and pre-emptive therapy (Analysis 2) of invasive mould diseases. In addition, we summarized the evidence available associated with the use of directed treatment strategies (Analysis 3). For empirical therapy, caspofungin proved superior to amphotericin B, liposomal amphotericin B, amphotericin B lipid complex and voriconazole in the outcome of survival, but no agents showed superiority for treatment response. There was no evidence of a difference between pre-emptive and empirical strategies on mortality outcomes. For directed therapy, voriconazole was superior to amphotericin B for overall survival, and both voriconazole and liposomal amphotericin B were superior to amphotericin B and amphotericin B colloidal dispersion on the outcome of response. While limited to some degree by the availability of RCTs, the MTCs reported here provide the best available evidence of relative therapeutic success for different available treatment strategies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Mixed treatment comparison of prophylaxis against invasive fungal infections in neutropenic patients receiving therapy for haematological malignancies: a systematic review

OBJECTIVES: Patients receiving therapy for haematological malignancies have a higher risk of invasive fungal infections (IFIs). Antifungal prophylaxis is an effective strategy against IFIs, but relative effectiveness estimates across agents are inconclusive. A mixed treatment comparison (MTC) was conducted to estimate the relative effectiveness of all agents for a number of outcomes of interest.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Treatment of invasive candidal infections: systematic review and meta-analysis

The review concluded that fluconazole was microbiologically inferior to amphotericin B and anidulafungin, but that amphotericin B was associated with a higher rate of adverse events when compared with fluconazole and echinocandins in patients with invasive candidiasis. The review was generally well conducted, but the reliability of the conclusions was unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Antifungal treatment for invasive Candida infections: a mixed treatment comparison meta-analysis

This review evaluated antifungal therapy on infection response rates, mortality and safety in adults with confirmed systemic fungal infection. The authors concluded that azoles and echinocandins were equally effective for treating invasive candidiasis and similar within-class effects were evident. Due to unclear study quality and concerns about the chosen method of synthesis, the reliability of these conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Empirical antifungal therapy for patients with neutropenia and persistent fever: systematic review and meta-analysis

The authors concluded that empirical anti-fungal treatment was associated with a significant reduction in the risk of invasive fungal infections, but not in all-cause mortality. However, the assessment of fungal infections may have been subject to bias. This is a generally well-conducted review and the authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Efficacy and safety of micafungin for invasive candida infections: a meta-analysis of randomized controlled trials

This review found that micafungin may offer a better safety and tolerability profile than several other antifungal agents in the prevention and treatment of invasive candida infections. The authors' conclusions were based on the evidence presented and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic review and meta-analysis of the tolerability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection

This review concluded that fluconazole and echinocandins were generally associated with lower risks of treatment termination and adverse liver events. Itraconazole and voriconazole was associated with a higher risk of liver injury. Limitations in the analysis mean that these conclusions are unlikely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

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