Pre-emptive antifungal therapy versus empirical antifungal therapy for febrile neutropenia in people with cancer

Uneno, Yu; Imura, Haruki; Makuuchi, Yosuke; Tochitani, Kentaro; Watanabe, Norio

doi:10.1002/14651858.cd013604.pub2

Cited by 6 publications

(10 citation statements)

References 34 publications

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“…Pooled data from adults with febrile neutropenia and IFD also indicated similar results. A 2022 Cochrane review found little to no difference in all‐cause mortality or mortality ascribed to fungal infection 16 . This finding was consistent with an earlier review published in 2015 14 .…”

Section: Discussionsupporting

confidence: 78%

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Systematic review on efficacy and safety of empirical versus pre‐emptive antifungal therapy among children with febrile neutropenia reveals paucity of data

Sachdeva,

Malik,

Pradhan

et al. 2024

Mycoses

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BackgroundTwo approaches are used to manage invasive fungal disease (IFD) in febrile neutropenic patients viz. empirical therapy (without attempting to confirm the diagnosis), or pre‐emptive therapy (after screening tests for IFD).ObjectiveThis systematic review was undertaken to compare these approaches in children.MethodsWe searched PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL, Clinical Trial Registries and grey literature, for randomized controlled trials (RCT) comparing empirical versus pre‐emptive antifungal therapy in children with FN suspected to have IFD. We used the Cochrane Risk of bias 2 tool for quality assessment, and evaluated the certainty of evidence using the GRADE approach.ResultsWe identified 7989 citations. Stepwise screening identified only one relevant RCT that administered empirical (n = 73) or pre‐emptive (n = 76) antifungal therapy. There were no significant differences in all‐cause mortality (RR 1.56, 95% CI: 0.46, 5.31), IFD mortality (RR 1.04, 95% CI:0.15, 7.20) and other clinically important outcomes such as duration of fever, duration of hospitalization and proportion requiring ICU admission. There were no safety data reported. The number of days of antifungal therapy was significantly lower in the pre‐emptive therapy arm. The certainty of evidence for all outcomes was ‘moderate’.ConclusionsThis systematic review highlighted the paucity of data, comparing empirical versus pre‐emptive antifungal therapy in children with febrile neutropenia having suspected invasive fungal disease. Data from a single included trial suggests that both approaches may be comparable in research settings. Robust trials are warranted to address the gap in existing knowledge about the optimal approach in clinical practice.

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Section: Discussionsupporting

confidence: 78%

“…This somewhat selective approach may reduce the undesirable effects associated with empirical therapy. The pros and cons of these approaches have been evaluated in adults, and the evidence indicated comparable mortality rates between the approaches 14–16 …”

Section: Introductionmentioning

confidence: 99%

Systematic review on efficacy and safety of empirical versus pre‐emptive antifungal therapy among children with febrile neutropenia reveals paucity of data

Sachdeva,

Malik,

Pradhan

et al. 2024

Mycoses

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“…Certainly, these data, interpreted together or sequentially, greatly increase the likelihood of IFI/IA and confidence in the introduction of antifungal treatment. 27 , 28 , 29 …”

Section: Discussionmentioning

confidence: 99%

“…These findings are described by other authors. 14 , 26 , 27 One can understand that these patients may have a large fungal burden, with greater angioinvasion, resulting in greater lung involvement and greater severity of cases. In addition, pulmonary involvement may be associated with more systemic severe repercussions and clinical instabilities.…”

Section: Discussionmentioning

confidence: 99%

Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital

Conterno,

Trabasso,

Resende

et al. 2024

The Brazilian Journal of Infectious Diseases

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“…Two main strategies have been utilized to treat IFI: a preemptive approach involving the use of diagnostic testing to guide treatment versus empiric antifungal therapy, where antifungal therapy is initiated while awaiting work-up. A recent Cochrane review concluded that pre-emptive antifungal treatment may reduce the duration of antifungal use without affecting IFI-related mortality in patients with febrile neutropenia when compared to empiric antifungal therapy, highlighting a need to study at-risk target populations and approaches to antifungal treatment [ 56 ]. The EORTC/MSG guidelines note that the T2Candida panel ® , approved by the United States Food and Drug Administration (FDA) for the detection of common Candida species from whole-blood specimens, has a high negative predictive value, which can also aid ASPs in decreasing antifungal use [ 54 ].…”

Section: Unmet Needs and Opportunities For Antimicrobial Stewardshipmentioning

confidence: 99%

Challenges and Opportunities in Antimicrobial Stewardship among Hematopoietic Stem Cell Transplant and Oncology Patients

et al. 2023

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Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple risk factors in the host populations and the infections that affect them. The consideration of underlying immunosuppression and a higher risk for poor outcomes have shaped therapeutic decisions for these patients. In this multidisciplinary perspective piece, we provide a summary of the current landscape of antimicrobial stewardship, unique challenges, and opportunities for unmet needs in these patient populations.

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Pre-emptive antifungal therapy versus empirical antifungal therapy for febrile neutropenia in people with cancer

Cited by 6 publications

References 34 publications

Systematic review on efficacy and safety of empirical versus pre‐emptive antifungal therapy among children with febrile neutropenia reveals paucity of data

Systematic review on efficacy and safety of empirical versus pre‐emptive antifungal therapy among children with febrile neutropenia reveals paucity of data

Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital

Challenges and Opportunities in Antimicrobial Stewardship among Hematopoietic Stem Cell Transplant and Oncology Patients

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