Antifungal Efficacy of Amphotericin B in Candida Albicans Endocarditis Therapy: Systematic Review

Braz J Cardiovasc Surg. 2020 Oct 1;35(5):789-796. doi: 10.21470/1678-9741-2019-0159.

Abstract

Introduction: Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare.

Objective: To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review.

Data search: Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years.

Study selection: Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations.

Data synthesis: From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association.

Conclusion: Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.

Keywords: Amphotericin B; Antifungal Agents; Candida Albicans; Endocarditis, Mycoses, Survival Rate.

Publication types

  • Systematic Review

MeSH terms

  • Amphotericin B* / therapeutic use
  • Antifungal Agents / therapeutic use*
  • Candida albicans*
  • Child
  • Cross-Sectional Studies
  • Endocarditis* / drug therapy
  • Endocarditis* / microbiology
  • Humans
  • Infant, Newborn

Substances

  • Antifungal Agents
  • Amphotericin B