Antifungal agents for preventing fungal infections in solid organ transplant recipients

Playford, E. G., Webster, A., Sorrell, T. and Craig, J. (2004) Antifungal agents for preventing fungal infections in solid organ transplant recipients. The Cochrane Database of Systematic Reviews, 3: CD004291-1-CD004291-63. doi:10.1002/14651858.CD004291.pub2

Author Playford, E. G.
Webster, A.
Sorrell, T.
Craig, J.
Title Antifungal agents for preventing fungal infections in solid organ transplant recipients
Journal name The Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2004
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004291.pub2
Issue 3
Start page CD004291-1
End page CD004291-63
Total pages 63
Place of publication London, U.K.
Publisher John Wiley & Sons
Collection year 2005
Language eng
Subject CX
321208 Primary Health Care
730305 Diagnostic methods
11 Medical and Health Sciences
1103 Clinical Sciences
Formatted abstract
Invasive fungal infections (IFIs) are important causes of morbidity and mortality in solid organ transplant recipients.

This study aims to systematically identify and summarise the effects of antifungal prophylaxis in solid organ transplant recipients.

Search strategy
The Cochrane Central Register of Controlled Trials, MEDLINE (from 1966), and EMBASE (from 1980) were searched. Reference lists, abstracts of conference proceedings and scientific meetings (1998-2003) were handsearched. Authors of included studies and pharmaceutical manufacturers were contacted.

Selection criteria
Randomised controlled trials (RCTs) in all languages comparing the prophylactic use of any antifungal agent or regimen with placebo, no antifungal, or another antifungal agent or regimen.

Data collection and analysis
Two reviewers independently applied selection criteria, performed quality assessment, and extracted data using an intention-to-treat approach. Differences were resolved by discussion. Data were synthesised using the random effects model and expressed as relative risk (RR) with 95% confidence intervals (95% CI).

Main results
Fourteen unique trials with 1497 randomised participants were included. Antifungal prophylaxis did not reduce mortality (RR 0.90, 95% CI 0.57 to 1.44). In liver transplant recipients, a significant reduction in IFIs was demonstrated for fluconazole (RR 0.28, 95% CI 0.13 to 0.57). Although less data were available for itraconazole and liposomal amphotericin B, indirect comparisons and one direct comparative trial suggested similar efficacy. Fluconazole prophylaxis did not significantly increase invasive infections or colonisation with fluconazole-resistant fungi. In renal and cardiac transplant recipients, neither ketoconazole nor clotrimazole significantly reduced invasive infections. Overall, the strength and precision of comparisons however were limited by a paucity of data.

Authors' conclusions

For liver transplant recipients, antifungal prophylaxis with fluconazole significantly reduces the incidence of IFIs with no definite mortality benefit. Given a 10% incidence of IFI, 14 liver transplant recipients would require fluconazole prophylaxis to prevent one infection. In transplant centres where the incidence of IFIs is high, or in situations where the individual risk is great, antifungal prophylaxis should be considered.
Keyword Antifungal agent
Q-Index Code CX
Additional Notes Published as a PDF 63 pages, Article no. CD004291

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Biological Sciences Publications
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Created: Wed, 15 Aug 2007, 05:30:02 EST