Cochrane · intervention · CD003807

Interventions for preventing oral candidiasis for patients with cancer receiving treatment

Clarkson, JE, Worthington, HV, Eden, TOB · Cochrane Database of Systematic Reviews · 2007 · Cochrane Library

Oral Health Oral medicine and oral cancer3 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

43

current version

GRADE rated

0

No studies

6

Included studies

28

as reported

No studies 6 · 14%Ungraded 37 · 86%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Anyone with cancer who received chemotherapy or radiotherapy or both	Patients with cancer, n=4226 assessed for oral candidiasis; adults only (17 trials); adults and children (8 trials); children only (2 trials); age unclear (1 trial)
Intervention	Any antifungal intervention for the prevention of oral candidiasis	Fluconazole (n=8); Ketoconazole (n=6); Itraconazole (n=4); Miconazole (n=1); Clotrimazole (n=3); Amphotericin B (n=5); Nystatin (n=5); Chlorhexidine (n=3); Nystatin plus chlorhexidine (n=1); Thymostimulin (n=1); Amphotericin B plus nystatin (n=1); Polyenes (n=2); Natamycin (n=1); Norfloxacin plus amphotericin B (n=1)
Comparison	Placebo; No treatment; Another active intervention	Placebo (n=11); No treatment (n=6); Saline rinse (n=1)
Outcomes	Oral candidiasis (present/absent); Relief of pain; Amount of analgesia; Relief of dysphagia; Incidence of systemic infection; Duration of stay in hospital (days); Cost of oral care; Patient quality of life; Death; Use of empirical antifungal treatment; Toxicity (adverse events probably due to drug); Compliance	Oral candidiasis (n=28); Systemic fungal infection (n=17); Death associated with fungal infection (n=8); Empirical antifungal treatment (n=8); Toxicity (n=13); Good compliance (n=5)
Study designs	Randomised controlled trials	Randomised controlled trials (n=28)
Timing	Not specified	Not specified

Search date: 2009-08. Databases: Cochrane Oral Health Group Trials Register; Cochrane Pain, Palliative and Supportive Care (PaPaS) Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE Pre-indexed; EMBASE; CINAHL; CANCERLIT via PubMed; OPEN SIGLE; LILACS

Questions and results

Show all 3 versions

Antifungal drugs absorbed from GI tract (fluconazole, ketoconazole, itraconazole) vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

12 questions

Outcome	Effect	Evidence	Status / GRADE
Systemic fungal infection same question in other reviews	RR 0.65 [0.37, 1.14]	6 studies · 1041 participants	Ungraded
Relief of dysphagia same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Cost of oral care same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Good compliance same question in other reviews	RR 1.06 [0.89, 1.27]	2 studies · 615 participants	Ungraded
Empirical antifungal treatment same question in other reviews	RR 0.85 [0.73, 0.99]	2 studies · 465 participants	Ungraded
Death associated with fungal infection same question in other reviews	RR 1.44 [0.14, 15.43]	3 studies · 718 participants	Ungraded
Patient quality of life same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Duration of stay in hospital (days) same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Amount of analgesia same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Relief of pain same question in other reviews	No trial reported this planned secondary outcome for any comparison in this review	NR	No studies
Toxicity (adverse events probably due to drug) same question in other reviews	RR 1.18 [0.84, 1.67]	3 studies · 871 participants	Ungraded
Oral candidiasis (present) same question in other reviews	RR 0.47 [0.29, 0.78]	7 studies · 1153 participants	Ungraded

Antifungal drugs partially absorbed from GI tract (miconazole, clotrimazole) vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

4 questions

Outcome	Effect	Evidence	Status / GRADE
Systemic fungal infection same question in other reviews	RR 2.27 [0.23, 22.56]	1 study · 32 participants	Ungraded
Oral candidiasis (present) same question in other reviews	RR 0.16 [0.06, 0.46]	4 studies · 292 participants	Ungraded
Toxicity (adverse events probably due to drug) same question in other reviews	2 studies, 60 participants; effect not estimable (no events reported)	2 studies · 60 participants	Ungraded
Empirical antifungal treatment same question in other reviews	RR 3.38 [0.15, 77.12]	1 study · 32 participants	Ungraded

Antifungal drugs not absorbed from GI tract vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

3 questions

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.69 [0.47, 1.01]	8 studies · 382 participants	Ungraded
Death associated with fungal infection same question in other reviews	RR 0.16 [0.01, 2.95]	1 study · 51 participants	Ungraded
Systemic fungal infection same question in other reviews	RR 0.1 [0.01, 1.75]	2 studies · 71 participants	Ungraded

Antifungal drugs absorbed from GI tract vs Antifungal drugs not absorbed from GI tract

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

6 questions

Outcome	Effect	Evidence	Status / GRADE
Systemic fungal infection same question in other reviews	RR 0.59 [0.33, 1.06]	8 studies · 2103 participants	Ungraded
Empirical antifungal treatment same question in other reviews	RR 0.89 [0.68, 1.16]	4 studies · 1031 participants	Ungraded
Death associated with fungal infection same question in other reviews	RR 1.25 [0.38, 4.13]	3 studies · 981 participants	Ungraded
Good compliance same question in other reviews	RR 1.05 [1.03, 1.08]	1 study · 820 participants	Ungraded
Oral candidiasis (present) same question in other reviews	RR 0.4 [0.21, 0.76]	8 studies · 2103 participants	Ungraded
Toxicity (adverse events probably due to drug) same question in other reviews	RR 0.88 [0.33, 2.3]	6 studies · 2018 participants	Ungraded

Itraconazole vs Fluconazole

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

6 questions

Outcome	Effect	Evidence	Status / GRADE
Toxicity (adverse events probably due to drug) same question in other reviews	2 studies, 232 participants; effect not estimable	2 studies · 232 participants	Ungraded
Empirical antifungal treatment same question in other reviews	RR 0.5 [0.05, 5.43]	1 study · 202 participants	Ungraded
Oral candidiasis (present) same question in other reviews	1 study (Huijgens 1999); no evidence of a difference; single-study total not pooled	1 study	Ungraded
Systemic fungal infection same question in other reviews	RR 1.0 [0.26, 3.89]	1 study · 202 participants	Ungraded
Death associated with fungal infection same question in other reviews	RR 0.14 [0.01, 2.73]	1 study · 202 participants	Ungraded
Good compliance same question in other reviews	RR 0.95 [0.85, 1.05]	1 study · 202 participants	Ungraded

Ketoconazole vs Itraconazole

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	1 study (Caselli 1990); no evidence of a difference; not estimable/not pooled	1 study	Ungraded

Ketoconazole 400 mg vs Ketoconazole 200 mg

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	1 study (Scrimgeour 1985); no patient experienced oral candidiasis, not estimable	1 study	Ungraded

Chlorhexidine vs Nystatin

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.89 [0.36, 2.21]	1 study · 34 participants	Ungraded

Chlorhexidine vs Chlorhexidine plus nystatin

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 1.62 [0.64, 4.1]	1 study · 52 participants	Ungraded

Nystatin vs Chlorhexidine plus nystatin

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 1.82 [0.73, 4.54]	1 study · 50 participants	Ungraded

Nystatin vs Natamycin

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 1.07 [0.83, 1.37]	1 study · 28 participants	Ungraded

Norfloxacin plus amphotericin B vs Amphotericin B

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

2 questions

Outcome	Effect	Evidence	Status / GRADE
Systemic fungal infection same question in other reviews	RR 0.67 [0.2, 2.23]	1 study · 106 participants	Ungraded
Oral candidiasis (present) same question in other reviews	RR 0.38 [0.15, 1.0]	1 study · 106 participants	Ungraded

Nystatin vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.92 [0.78, 1.08]	3 studies · 153 participants	Ungraded

Amphotericin B vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.46 [0.18, 1.23]	2 studies · 48 participants	Ungraded

Chlorhexidine vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.59 [0.19, 1.83]	3 studies · 115 participants	Ungraded

Thymostimulin vs Placebo or no treatment

Population: Patients with cancer receiving chemotherapy or radiotherapy or both

1 question

Outcome	Effect	Evidence	Status / GRADE
Oral candidiasis (present) same question in other reviews	RR 0.4 [0.12, 1.32]	1 study · 35 participants	Ungraded