Gafter-Gvili Anat, Vidal Liat, Goldberg Elad, Leibovici Leonard, Paul Mical
Department of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, 49100 Petah-Tiqva, Israel.
Mayo Clin Proc. 2008 Sep;83(9):1011-21. doi: 10.4065/83.9.1011.
To compare available antifungal treatments for invasive candidiasis, a leading cause of nosocomial bloodstream infections.
We performed a systematic review and meta-analysis of randomized controlled trials that compared different antifungal agents for the treatment of candidemia and other forms of invasive candidiasis. Two reviewers independently appraised the quality of trials and extracted data. The primary outcome was all-cause mortality, and secondary outcomes were microbiological failure, treatment failure, and adverse events. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled.
Of the 15 included trials, 9 compared fluconazole with other drugs (amphotericin B, itraconazole, or a combination of fluconazole and amphotericin B), 4 compared echinocandins with other drugs (fluconazole, amphotericin B, liposomal amphotericin B), 1 compared micafungin and caspofungin, and 1 compared amphotericin B plus fluconazole and voriconazole. No difference in mortality was observed with fluconazole vs amphotericin B (RR, 0.92; 95% CI, 0.72-1.17); however, the rate of microbiological failure increased in the fluconazole arm (RR, 1.52; 95% CI, 1.12-2.07). Anidulafungin decreased the rate of microbiological failure compared with fluconazole (RR, 0.50; 95% CI, 0.29-0.86) with fewer adverse events. Caspofungin was comparable to amphotericin B in mortality and efficacy, with fewer adverse events requiring discontinuation (RR, 0.11; 95% CI, 0.04-0.36). Micafungin was comparable to liposomal amphotericin B in mortality.
All assessed antifungal agents showed similar efficacy, but the rate of microbiological failure increased with fluconazole vs amphotericin B or anidulafungin. Amphotericin B is associated with a higher rate of adverse events than fluconazole and echinocandins.
比较用于治疗侵袭性念珠菌病（医院血流感染的主要原因）的现有抗真菌治疗方法。
我们对比较不同抗真菌药物治疗念珠菌血症和其他形式侵袭性念珠菌病的随机对照试验进行了系统评价和荟萃分析。两名评价者独立评估试验质量并提取数据。主要结局为全因死亡率，次要结局为微生物学治疗失败、治疗失败和不良事件。汇总了具有95%置信区间（CI）的相对风险（RR）。
在纳入的15项试验中，9项比较了氟康唑与其他药物（两性霉素B、伊曲康唑或氟康唑与两性霉素B的联合用药），4项比较了棘白菌素与其他药物（氟康唑、两性霉素B、脂质体两性霉素B），1项比较了米卡芬净和卡泊芬净，1项比较了两性霉素B加氟康唑和伏立康唑。氟康唑与两性霉素B相比，死亡率无差异（RR，0.92；95%CI，0.72 - 1.17）；然而，氟康唑组的微生物学治疗失败率增加（RR，1.52；95%CI，1.12 - 2.07）。与氟康唑相比，阿尼芬净降低了微生物学治疗失败率（RR，0.50；95%CI，0.29 - 0.86），且不良事件较少。卡泊芬净在死亡率和疗效方面与两性霉素B相当，因不良事件停药的情况较少（RR，0.11；95%CI，0.04 - 0.36）。米卡芬净在死亡率方面与脂质体两性霉素B相当。
所有评估的抗真菌药物均显示出相似的疗效，但与两性霉素B或阿尼芬净相比，氟康唑的微生物学治疗失败率增加。两性霉素B与氟康唑和棘白菌素相比，不良事件发生率更高。
