The Effect Of Azole Drugs Antifungal Prophylaxis On Amphotericin B Treatment Of Invasive Fungal Infections: A Meta-analysis

ObjectiveThe Infectious Diseases Society of America (2002) and the Infectious DiseasesWorking Party of the German Society for Haematology and Onconogy(2008) arerecommended in patients with neutropenia after chemotherapy azole drug prevention ofinvasive fungal infections, Once patients diagnosed with invasive fungal infections, chosepolyene drugs for treatment. But it is based on meta analysis of all the prophylactic use ofantifungal drugs, lack of meta analysis of prophylactic use of azole drugs alone. Thisresearch through the meta analysis method validation whether there is a reliable methodof this kind of order medicine based on evidence-based medicine.Methods1. Data were retrieved form January1966and February1966of Pubmed, EMBASE,Web of Science, The Cochrane Central Register of Controlled Trials, EBSCO, Ovid,Chinese Journals Full-text Database, Chinese Biomedical Database and Wan Fang DigitalJournal Full-text database to collect clinical randomized controlled trials regarding theprophylactic use of azole drugs in patients with neutropenia after chemotherapy."fluconazole","itraconazole","ketoconazole","miconazole","voriconazole","posaconazole","azole drugs" and "amphotericin B","Ambisome, L-amB "," amphotericin Blipid complex","amphotericin B colloidal dispersion","antifungal","candida","yeast","mould","aspergillus","zygomycosis","fungus","neutropenia","chemotherapy","cancer","bone marrow transplant","leukemia" and "prophylaxis" as keywords.2. For the literature which conforming to the inclusion criteria, records the dataabout of all-cause mortality and mortality attributed to invasive fungal infections inprophylactic use of azole drugs group and control group(placebo or no treatment)respectively.3. Statistical analysis was performed by Meta-analysis using Review Manager5.2,the results of the meta-analysis were showed as relative risk(RR) and its95%confidenceinterval(CI), the funnel chart combining with Egger method and Begg method are used toinspect the potential publication bias. ResultsEight randomized controlled trials including1435cases met the inclusion criteria.Meta-analysis showed that:1. mortality attributed to invasive fungal infectionsAzoles antifungal prophylaxis group compared with control group(placebo or notreatment), the results show that the prophylactic use of azole drugs before the applicationof amphotericin B treatment, can reduced of mortality attributed to invasive fungalinfections in patients with neutropenia after chemotherapy(RR:0.39,95%CI:0.18~0.86,P=0.21).2. all-cause mortalityThe results show that the prophylactic use of azole drugs before the application ofamphotericin B treatment, there were no statistically significant differences between theazoles antifungal prophylaxis group and control group(placebo or no treatment) in theall-cause mortality of patients with neutropenia after chemotherapy(RR:1.14,95%CI:0.90~1.45, P=0.95).ConclusionsThe prophylactic use of azole drugs before the application of amphotericin Btreatment, can reduced of mortality attributed to invasive fungal infections in patients withneutropenia after chemotherapy, but there were no statistically significant about all-causemortality.