Risk of resistance associated with fluconazole prophylaxis: Systematic review

Luc P. Brion, Smart E. Uko, David L. Goldman

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background: Several studies have shown that fluconazole prophylaxis reduces the risk of fungal colonization and of invasive fungal infection in high-risk patients with minimal toxicity. This systematic review was designed to estimate the risk of emergence of colonization and infection either with azole susceptible-dose dependent or with resistant strains. Methods: We searched Medline, EMBASE, the Cochrane Collaboration database and our own files for randomized controlled trials assessing the effect of fluconazole on the incidence of fluconazole-resistant strains. Results: This systematic review of randomized clinical trials shows that fluconazole prophylaxis increases the risk for colonization with fluconazole susceptible-dose dependent or with resistant yeasts, the percentage of non-albicans Candida isolates and the percentage of fluconazole susceptible-dose dependent or resistant fungal isolates. Fluconazole prophylaxis did not significantly affect the risk of invasive disease with fluconazole susceptible-dose dependent or resistant fungi. The sample size was too small to assess the effect of fluconazole prophylaxis on the risk for breakthrough infections with non-albicans Candida. Conclusion: Evidence from randomized trials suggests that fluconazole prophylaxis increases the risk for colonization with fluconazole susceptible-dose dependent or with resistant fungi, but does not significantly affect the risk for invasive infections with fluconazole susceptible-dose dependent or with resistant fungi. The risk for breakthrough infections remains a concern and needs to be addressed in large prospective studies.

Original languageEnglish (US)
Pages (from-to)521-529
Number of pages9
JournalJournal of Infection
Volume54
Issue number6
DOIs
StatePublished - Jun 2007

Fingerprint

Fluconazole
Fungi
Infection
Candida
Randomized Controlled Trials
Azoles
Sample Size
Yeasts
Databases
Prospective Studies

Keywords

  • Candida
  • Fluconazole
  • Invasive fungal infection
  • Meta-analysis
  • Prophylaxis
  • Resistance
  • Systematic review

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

Risk of resistance associated with fluconazole prophylaxis : Systematic review. / Brion, Luc P.; Uko, Smart E.; Goldman, David L.

In: Journal of Infection, Vol. 54, No. 6, 06.2007, p. 521-529.

Research output: Contribution to journalArticle

Brion, Luc P. ; Uko, Smart E. ; Goldman, David L. / Risk of resistance associated with fluconazole prophylaxis : Systematic review. In: Journal of Infection. 2007 ; Vol. 54, No. 6. pp. 521-529.
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