Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Antifungal treatment for invasive Candida infections: A mixed treatment comparison meta-analysis
Annals of Clinical Microbiology and Antimicrobials, Volume 8, Article 23, Year 2009
Notification
URL copied to clipboard!
Description
Objectives: Invasive fungal infections are a major cause of mortality among patients at risk. Treatment guidelines vary on optimal treatment strategies. We aimed to determine the effects of different antifungal therapies on global response rates, mortality and safety. Methods: We searched independently and in duplicate 10 electronic databases from inception to May 2009. We selected any randomized trial assessing established antifungal therapies for confirmed cases of invasive candidiasis among predominantly adult populations. We performed a meta-analysis and then conducted a Bayesian mixed treatment comparison to differentiate treatment effectiveness. Sensitivity analyses included dosage forms of amphotericin B and fluconazole compared to other azoles. Results: Our analysis included 11 studies enrolling a total of 965 patients. For our primary analysis of global response rates, we pooled 7 trials comparing azoles to amphotericin B, Relative Risk [RR] 0.87 (95% Confidence Interval [CI], 0.78-0.96, P = 0.007, I2 = 43%, P = 0.09. We also pooled 2 trials of echinocandins versus amphotericin B and found a pooled RR of 1.10 (95% CI, 0.99-1.23, P = 0.08). One study compared anidulafungin to fluconazole and yielded a RR of 1.26 (95% CI, 1.06-1.51) in favor of anidulafungin. We pooled 7 trials assessing azoles versus amphotericin B for all-cause mortality, resulting in a pooled RR of 0.88 (95% CI, 0.74-1.05, P = 0.17, I2 = 0%, P = 0.96). Echinocandins versus amphotericin B (2 trials) for all-cause mortality resulted in a pooled RR of 1.01 (95% CI, 0.84-1.20, P = 0.93). Anidulafungin versus fluconazole resulted in a RR of 0.73 (95% CI, 0.48-1.10, P = 0.34). Our mixed treatment comparison analysis found similar within-class effects across all interventions. Adverse event profiles differed, with amphotericin B exhibiting larger adverse event effects. Conclusion: Treatment options appear to offer preferential effects on response rates and mortality. When mycologic data are available, therapy should be tailored. © 2009 Mills et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2713200/bin/1476-0711-8-23-S1.doc
Authors & Co-Authors
Mills, Edward J.
Canada, Burnaby
Simon Fraser University
Canada, Hamilton
Mcmaster University
Perri, Dan
Canada, Hamilton
Mcmaster University
Cooper, Curtis L.
Canada, Ottawa
L'hôpital D'ottawa
Nachega, J. B.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
Wu, Pingping
Canada, Hamilton
Mcmaster University
Tleyjeh, Imad M.
Saudi Arabia, Riyadh
King Faisal Specialist Hospital and Research Centre
United States, Rochester
Mayo Clinic
Phillips, Peter
Canada, Vancouver
The University of British Columbia
Statistics
Citations: 7
Authors: 7
Affiliations: 8
Identifiers
Doi:
10.1186/1476-0711-8-23
e-ISSN:
14760711
Study Approach
Systematic review