Risk of resistance associated with fluconazole prophylaxis: Systematic review

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

Research output: Contribution to journalArticle

59 Scopus citations

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
Publication statusPublished - Jun 1 2007

    Fingerprint

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this