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Interventions for preventing oral candidiasis for patients with cancer receiving treatment

  • Review
  • Intervention




Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent and treat them. One of these side effects is oral candidiasis.


To assess the effectiveness of interventions (which may include placebo or no treatment) for the prevention of oral candidiasis for patients with cancer receiving chemotherapy or radiotherapy or both.

Search methods

Computerised searches of Cochrane Oral Health Group and PaPaS Trials Registers, CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, SIGLE and LILACS were undertaken.
Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information.
Date of the most recent searches: 3 August 2009: CENTRAL (The Cochrane Library 2009, Issue 3).

Selection criteria

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone receiving chemotherapy or radiotherapy treatment for cancer; interventions - agents prescribed to prevent oral candidiasis; primary outcome - prevention of oral candidiasis.

Data collection and analysis

Data were recorded on the following secondary outcomes if present: 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 and compliance.
Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. The Cochrane Collaboration statistical guidelines were followed and risk ratios (RR) calculated using random-effects models. Potential sources of heterogeneity were examined in random-effects metaregression analyses.

Main results

Twenty-eight trials involving 4226 patients satisfied the inclusion criteria. Drugs absorbed and partially absorbed from the gastrointestinal (GI) tract were found to prevent oral candidiasis when compared to a placebo, or a no treatment control group, with RR for absorbed drugs = 0.47 (95% confidence interval (CI) 0.29 to 0.78). For absorbed drugs in populations with an incidence of 20% (mid range of results in control groups), this implies a number needed to treat (NNT) of 9 (95% CI 7 to 13) patients need to be treated to avoid one patient getting oral candidiasis. There was no significant benefit shown for drugs not absorbed from the GI tract.

Authors' conclusions

There is strong evidence, from randomised controlled trials, that drugs absorbed or partially absorbed from the GI tract prevent oral candidiasis in patients receiving treatment for cancer. There is also evidence that these drugs are significantly better at preventing oral candidiasis than drugs not absorbed from the GI tract.








我們使用電腦搜尋了Cochrane Oral Health Group、PAPAS Trials Registers、CENTRAL、MEDLINE、EMBASE、CINAHL、CANCERLIT、SIGLE 及LILACS。我們也搜尋了相關文獻所列出的參考資料,並聯絡合適試驗的作者,來確認試驗的內容及額外的資訊。最近的搜尋日期為2006年六月: CENTRAL (The Cochrane Library 2006, Issue 2)。




若出現下列次要結果,則資料會被加以記錄:緩和疼痛,止痛的程度,緩和吞嚥困難,系統性感染的發生率,住院的時間(天數),口腔照護的花費,患者的生活品質,死亡,使用經驗性的抗黴菌治療,毒性以及相容性。關於實驗方法,實驗參與者,介入法,結果的量測以及最終結果等資料,都由兩位評論作者獨立的且重複的檢視。並依據Cochrane Oral Health Group statistical guidelines及利用randomeffects model計算risk ratios (RR)。若有潛在異質性的來源,則使用randomeffects metaregression analysis來檢驗。


28個試驗,總共4226位患者符合選擇的條件。用於防止口腔白色念珠菌感染且經由腸胃道吸收或部分吸收的藥物,與安慰劑,或是沒有治療的控制組作比較,吸收性藥物的risk ratio = 0.47 (95% confidence interval (CI) 0.29 to 0.78)。對於在20% incidence族群中的吸收性藥物 (控制組結果的mid range),這暗示了9位需要治療的患者中(95% CI 7 to 13)有一位能避免口腔念珠菌感染。非腸胃道吸收的藥物並沒有顯現出顯著的益處。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。










コンピューター検索ではCochrane Oral Health Group and PAPAS Trials Registers、 CENTRAL、 MEDLINE、 EMBASE、 CINAHL、CANCERLIT、 SIGLE and LILACSを使用した。関連する論文の参考文献を検索し、適合した論文の著者とコンタクトをとり、さらなる情報を入手した。最終検索日:2006年6月:CENTRAL(The Cochrane Library 2006、 Issue 2)。






4226人の被験者が関係している28の試験は、選択基準を満たした。胃腸から吸収、部分的な吸収をする薬は、プラセボや無治療群に比較して口腔カンジダ症を予防することが分かった。そのRRは0.47(95%信頼区間0.29, 0.78)であった。20%の発症率を持つ集団(対照群の結果の中央値)に対して吸収薬を投与することは、口腔カンジダ症に罹る患者を一人避けるために必要な患者数はNNT9(95%信頼区間7, 13)で有ることを意味する。胃腸から吸収されない薬に関しては有意差なしであった。




監  訳: 木森 久人,湯浅 秀道,JCOHR,2008.4.1

実施組織: 厚生労働省委託事業によりMindsが実施した。

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Plain language summary

Interventions for preventing oral candidiasis for patients with cancer receiving treatment

There is strong evidence that some antifungal drugs prevent oral candidiasis (thrush) caused by cancer treatment, but nystatin does not appear to work.
Treatment for cancer can lead to severe fungal infections (thrush) in the mouth. This can cause discomfort, pain, difficulties in eating, longer stays in hospital and more worryingly, systemic infection and risk to life. Different drugs are used to try and prevent this condition. The review found strong evidence from a large number of trials that some of the antifungal drugs (those absorbed and partially absorbed into the body) help prevent fungal infections in the mouth. Some other commonly used drugs such as nystatin, which are not absorbed into the body, do not appear to work.

Laički sažetak

Postupci za sprječavanje gljivične infekcije usta kod oboljelih od karcinoma koji primaju terapiju

Postoje čvrsti dokazi da određeni lijekovi protiv gljivičnih infekcija sprječavaju oralnu kandidijazu (infekciju usta kandidom) koja nastaje uslijed liječenja karcinoma, ali se čini da nistatin nije učinkovit. Liječenje karcinoma može dovesti do teških gljivičnih infekcija u ustima, što može uzrokovati neugodu, bol, otežano uzimanje hrane, dulji boravak u bolnici i, što je opasnije, infekciju cijelog tijela i opasnost po život. Iskušani su različiti lijekovi za prevenciju ovoga stanja. Cochrane sustavni pregled pronašao je čvrste dokaze iz velikog broja istraživanja da određeni lijekovi protiv gljivičnih infekcija, koji se upijaju potpuno ili djelomično u tijelo, mogu spriječiti gljivične infekcije usta. Za neke druge lijekove koji se često koriste, kao što je nistatin koji se ne upija u tijelo, nisu pronađeni dokazi o učinkovitosti.

Bilješke prijevoda

Prevoditelj:: Croatian Branch of the Italian Cochrane Centre

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