Antifungal agents in preventing oral candidiasis in clinical oncology: A network meta‐analysis

Abstract

Cancer treatment, especially chemotherapy and radiotherapy will lead to short and long-term adverse events which may be distressing and potentially fatal for cancer patients. Opportunistic fungal infections like oral candidiasis (OC) that affects the mucosal layer of the oral cavity due to the overgrowth of Candida species, notably Candida albicans is a relatively common adverse effect of cancer treatment (Akpan & Morgan, 2002). Recent evidence shows that there is approximately 90% of oral Candida carriage rate in patients receiving chemotherapy, which is twice the amount found in

Effectiveness of fluconazole as antifungal prophylaxis in cancer patients undergoing chemotherapy, radiotherapy, or immunotherapy: systematic review and meta‐analysis

“…In the present review, the comparison of fluconazole with clotrimazole was also limited due to the low number of studies; concerning the agents evaluated in this review, there were no differences between fluconazole and other antifungals, not even for the evaluation of adverse effects. Consequently, although fluconazole is rated as the safest among the antifungal agents [12], the evidence to recommend it as the choice over other agents is low.…”

“…Polyenes have lipophilic (chromophores with four to seven double-conjugated ligations) and hydrophilic regions, and the greater the number of double-conjugated ligations, the greater their antifungal activity and less toxicity [45]. In this sense, amphotericin B presents seven of those ligations and is more active against fungi than nystatin, being possible to use the parenteral route for its administration [12]. In contrast, amphotericin B is poorly absorbed when administered orally, as performed in the primary studies of this review, which could justify the reduced effectiveness of the compound [54].…”

“…Finally, 157 studies were comprehensively reviewed, out of which 19 were selected. Furthermore, five studies were rescued from a previous review [12]. Twenty-four studies were then definitely included in this systematic review (Fig.…”

“…Among the antifungal agents, fluconazole has been frequently indicated, presenting a good pharmacokinetic profile, lower toxicity, reduced pharmacological interaction, and excellent bioavailability. In addition, fluconazole is effective in reducing fungal colonization and has greater acceptance by patients because it is an easy‐to‐administer drug at a low cost [12]. Therefore, this systematic review aimed to evaluate the effectiveness of prophylaxis with fluconazole compared to other antifungal agents or no treatment (placebo/untreated) in cancer patients undergoing radiotherapy, chemotherapy, and immunotherapy.…”

Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis

“…Comparing itraconazole to ketoconazole, itraconazole was found to be more efficacious than ketoconazole; however, this difference was not statistically significant [16]. However, when comparing fluconazole against ketoconazole, fluconazole was found to be superior [17][18][19]. Posaconazole was reported to be as efficacious as fluconazole, although it is worth taking note that with posaconazole, more patients remained symptom-free and fewer patients had clinical relapse compared to fluconazole [20].…”