A Randomized Trial Comparing Fluconazole with Amphotericin B for the Treatment of Candidemia in Patients without Neutropenia

Abstract

In patients without neutropenia and without major immunodeficiency, fluconazole and amphotericin B are not significantly different in their effectiveness in treating candidemia.

Fungicidal versus fungistatic therapy of invasive Candida infection in non-neutropenic adults: a meta-analysis

“…A total of 1335 eligible subjects were enrolled in the eight included trials (Kujath et al 1993; Rex et al 1994, 2003; Abele-Horn et al 1996; Anaissie et al 1996; Phillips et al 1997; Kullberg et al 2005; Reboli et al 2007) (Table 2). All of the studies were published in peer-reviewed, English-language journals between 1993 and 2014.…”

“…The total number of eligible subjects in the studies ranged from 40 to 370. Of the eight studies, half enrolled more than 100 eligible patients (Rex et al 1994, 2003; Kullberg et al 2005; Reboli et al 2007) and 6 were multicentre (Rex et al 1994, 2003; Anaissie et al 1996; Phillips et al 1997; Kullberg et al 2005; Reboli et al 2007). Although all studies were randomised, only two claimed blinding through the study (Rex et al 2003; Reboli et al 2007).…”

“…Although all studies were randomised, only two claimed blinding through the study (Rex et al 2003; Reboli et al 2007). In two cases, the study was blinded at initial randomisation but not during the entire course of the study (Rex et al 1994; Kullberg et al 2005) (Table 1). …”

“…In two cases, the study was blinded at initial randomisation but not during the entire course of the study (Rex et al 1994; Kullberg et al 2005) (Table 1). …”

“…Candidemia was the enrolment criterion in four of the trials (Rex et al 1994, 2003; Phillips et al 1997; Kullberg et al 2005); the others allowed entry on the basis of invasive candidiasis without documented candidemia (Kujath et al 1993; Abele-Horn et al 1996; Anaissie et al 1996; Reboli et al 2007). Five of the studies specifically excluded neutropenic subjects (Rex et al 1994, 2003; Abele-Horn et al 1996; Phillips et al 1997; Kullberg et al 2005). In one study, invasive Candida cases associated with neutropenia (polymorphonuclear leucocyte count <1000/μL) were removed from the data set with only the remaining cases retained for analysis (Anaissie et al 1996).…”