氟康唑
医学
制霉菌素
内科学
相对风险
荟萃分析
随机对照试验
两性霉素B
安慰剂
不利影响
中止
癌症
入射(几何)
外科
胃肠病学
置信区间
抗真菌
皮肤病科
病理
物理
光学
替代医学
作者
Wilmer Ramírez-Carmona,Gabriela L. Fernandes,Beatriz Díaz-Fabregat,Evelyn Carmo Oliveira,Rosana Leal do Prado,Juliano Pelim Pessan,Douglas Roberto Monteiro
出处
期刊:Apmis
[Wiley]
日期:2023-05-18
被引量:1
摘要
This review assessed the effectiveness of fluconazole as antifungal prophylaxis on the incidence of oral fungal diseases in patients undergoing cancer treatment. The secondary outcomes evaluated were the adverse effects, discontinuation of cancer therapy due to oral fungal infection, mortality by a fungal infection, and the mean duration of antifungal prophylaxis. Twelve databases and records were searched. The RoB 2 and ROBINS I tools were used to assess the risk of bias. The relative risk (RR), risk difference, and standard mean difference (SMD) were applied with 95% confidence intervals (CI). The certainty of the evidence was determined by GRADE. Twenty-four studies were included in this systematic review. In randomized controlled trials pooling, fluconazole was a protective factor for the primary outcome (RR = 0.30; CI: 0.16, 0.55; p < 0.01, vs placebo). Compared to other antifungals, fluconazole was only more effective than the subgroup of amphotericin B and nystatin (alone or in combination) (RR = 0.19; CI: 0.09, 0.43; p < 0.01). Fluconazole was also a protective factor in non-randomized trials pooling (RR = 0.19; CI: 0.05, 0.78; p = 0.02, vs untreated). The results showed no significant differences for the secondary outcomes. The certainty of the evidence was low and very low. In conclusion, prophylactic antifungals are necessary during cancer treatment, and fluconazole was shown to be more effective in reducing oral fungal diseases only compared with the subgroup assessing amphotericin B and nystatin, administered alone or in combination.
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