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Prophylactic and empirical antifungal treatment in cancer complicated by neutropenia

BMJ 1997; 315 doi: (Published 23 August 1997) Cite this as: BMJ 1997;315:488

Combining different antifungal strategies in same systematic review is inappropriate

  1. Christopher C Kibbler, Consultant in medical microbiologya,
  2. Rohini Manuel, Clinical research fellowa,
  3. H Grant Prentice, Professor of haematologya
  1. a Departments of Medical Microbiology and Haematology, Royal Free Hospital, London NW3 2QG
  2. b Nordic Cochrane Centre, Rigshospitalet, DK-2200 Copenhagen, Denmark

    Editor—Peter C Gøtzsche and Helle Krogh Johansen have concluded that antifungal agents should be restricted to neutropenic patients with proved fungal infections.1 Their meta-analysis, however, combined incompatible studies and was not systematic, omitting several randomised placebo controlled trials of antifungal prophylaxis (for example, that by Schaffner and Schaffner2) and including incomplete studies.3 We are concerned that this study has now been placed in the Cochrane database, where it will be seen to be the last word on the use of antifungal agents in neutropenic patients.

    The authors have examined the impact of prophylaxis and treatment in the same analysis. In fact, they have combined four different strategies—prophylaxis, early empirical treatment (at the onset of fever), delayed empirical treatment (after three to four days of unresponsive fever), and later empirical treatment (after seven days of persistent fever)—to draw an overall conclusion about individual agents. In addition, the authors include a study from 1980 (when the mortality in this population, as …

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