Seven RCTs with 830 patients were included in the review.
In terms of study quality, 6 RCTs had adequate allocation concealment and these were also double-blind. The remaining study was unclear on these criteria.
The proportion of patients with candidaemia was significantly lower in the fluconazole groups (RR 0.21, 95% CI: 0.06, 0.72, p=0.01; I-squared 0%). The proportion of patients with fungal infections other than lower urinary tract infection was also significantly lower in the fluconazole groups (RR 0.39, 95% CI: 0.24, 0.65, p=0.0003; I-squared 0%). The proportion of patients requiring systemic amphotericin B as rescue therapy for systemic fungal infection was significantly lower in the fluconazole groups (RR 0.35, 95% CI: 0.17, 0.72, p=0.004; I-squared 0%).
There was no significant difference between the fluconazole and placebo groups in the incidence of hospital mortality (RR 0.82, 95% CI: 0.62, 1.08, p=0.15; I-squared 7%).
There was no significant difference between the fluconazole and placebo groups in the length of hospital stay (WMD -0.4 days, 95% CI: -10.35, 9.54, p=0.94; I-squared 52.4%).
There was no significant difference between the fluconazole and placebo groups in the proportion of patients colonised or infected with fluconazole-resistant fungi (RR 0.66, 95% CI: 0.22, 1.96, p=0.46; I-squared 0%).
There was no significant difference between the fluconazole and placebo groups in the proportion of patients experiencing adverse events leading to the cessation of therapy (RR 0.75, 95% CI: 0.22, 2.58, p=0.65; I-squared 0%).
There was some indication from the funnel plot that publication bias may have been present, as there was a lack of small studies showing a null effect on the outcome of hospital mortality.