Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan.
Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan.
Int J Antimicrob Agents. 2019 Jun;53(6):789-794. doi: 10.1016/j.ijantimicag.2019.02.019. Epub 2019 Mar 2.
The aim of this meta-analysis was to assess the efficacy and safety of treatment with echinocandins compared with amphotericin B in paediatric patients with invasive candidiasis.
PubMed, Embase and Cochrane databases were searched up to August 2018. Only randomized controlled trials (RCTs) evaluating echinocandins and amphotericin B in the treatment of paediatric patients with invasive candidiasis were included. The outcomes were clinical responses and adverse effects.
Five RCTs of 354 patients (191 patients in the echinocandins group and 163 patients in the amphotericin B group) were included in this study. Overall, no significant differences in clinical response were found between echinocandins and amphotericin B (odds ratio [OR], 1.38; 95% confidence interval [CI], 0.68-2.80; I = 39%). Similar results were also observed in the high-risk group (OR, 3.10; 95% CI, 0.10-97.23; I = 76%), the low-risk group (OR, 1.29; 95% CI, 0.36-4.62; I = 21%) and the neutropenia group (OR, 1.56; 95% CI, 0.75-3.26; I = 0%). The risk of discontinuing treatment because of adverse effects was significantly lower in the echinocandins group than in the amphotericin B group (OR, 0.30, 95% CI, 0.12-0.76; I = 0%).
There were no differences in efficacy between the echinocandins group and the amphotericin B group in the treatment of invasive candidiasis in paediatric patients. However, the echinocandins group had a significantly lower risk of discontinuing treatment than the amphotericin B group.
本荟萃分析旨在评估棘白菌素类药物与两性霉素 B 治疗侵袭性念珠菌病患儿的疗效和安全性。
检索了 PubMed、Embase 和 Cochrane 数据库，截至 2018 年 8 月。仅纳入评估棘白菌素类药物和两性霉素 B 治疗侵袭性念珠菌病患儿的随机对照试验（RCT）。结局为临床反应和不良反应。
本研究纳入了 5 项 RCT，共 354 例患儿（棘白菌素类药物组 191 例，两性霉素 B 组 163 例）。总体而言，棘白菌素类药物与两性霉素 B 的临床反应无显著差异（比值比 [OR]，1.38；95%置信区间 [CI]，0.68-2.80；I²=39%）。高危组（OR，3.10；95% CI，0.10-97.23；I²=76%）、低危组（OR，1.29；95% CI，0.36-4.62；I²=21%）和中性粒细胞减少组（OR，1.56；95% CI，0.75-3.26；I²=0%）也观察到类似结果。因不良反应停药的风险在棘白菌素类药物组显著低于两性霉素 B 组（OR，0.30；95% CI，0.12-0.76；I²=0%）。
棘白菌素类药物与两性霉素 B 治疗儿童侵袭性念珠菌病的疗效无差异。然而，棘白菌素类药物组因不良反应停药的风险显著低于两性霉素 B 组。
