共 50 条
Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology
被引:22
作者:
Morgan, Jessica E.
[1
,2
]
Hassan, Hadeel
[2
]
Cockle, Julia V.
[2
]
Lethaby, Christopher
[2
]
James, Beki
[2
]
Phillips, Robert S.
[1
,2
]
机构:
[1] Univ York, Ctr Reviews & Disseminat, York YO10 5DD, N Yorkshire, England
[2] Leeds Teaching Hosp NHS Trust, Dept Paediat Haematol & Oncol, Great George St, Leeds LS1 3EX, W Yorkshire, England
基金:
英国医学研究理事会;
关键词:
Fungal infection;
Paediatric;
Guideline;
Critical review;
INFECTIOUS-DISEASES-SOCIETY;
INVASIVE FUNGAL DISEASES;
ESCMID-DAGGER;
2007;
UPDATE;
MANAGEMENT;
DIAGNOSIS;
CANCER;
PREVENTION;
ASPERGILLOSIS;
PROPHYLAXIS;
D O I:
10.1007/s00520-016-3412-y
中图分类号:
R73 [肿瘤学];
学科分类号:
100214 ;
摘要:
The incidence of invasive fungal disease (IFD) is rising, but its treatment in paediatric haematology and oncology patients is not yet standardised. This review aimed to critically appraise and analyse the clinical practice guidelines (CPGs) that are available for paediatric IFD. Electronic searches of MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, the Guidelines International Network (GIN), and Google were performed and combined fungal disease (Fung* OR antifung*OR Candida* OR Aspergill*) with prophylaxis or treatment (prophyl* OR therap* OR treatment). All guidelines were assessed using the AGREE II tool and recommendations relating to prophylaxis, empirical treatment and specific therapy were extracted. Nineteen guidelines met the inclusion criteria. The AGREE II scores for the rigour of development domain ranged from 11 to 92 % with a median of 53 % (interquartile range 32-69 %). Fluconazole was recommended as antifungal prophylaxis in all nine of the included guidelines which recommended a specific drug. Liposomal amphotericin B was recommended in all five guidelines giving empirical therapy recommendations. Specific therapy recommendations were given for oral or genital candidiasis, invasive candida infection, invasive aspergillosis and other mould infections. In many areas, recommendations were clear about appropriate practice but further clarity was required, particularly relating to the decision to discontinue empirical antifungal treatment, the relative benefits of empiric and pre-emptive strategies and risk stratification. Future CPGs could consider working to published guideline production methodologies and sharing summaries of evidence appraisal to reduce duplication of effort, improving the quality and efficiency of CPGs in this area.
引用
收藏
页码:221 / 228
页数:8
相关论文
共 50 条