Our current understanding of therapies for invasive fungal infections
This article provides an update on the current state of the art for treating invasive fungal infections, with insights, based on the experience of the author, into future directions for antifungal treatment strategies. Amphotericin B deoxycholate (amBd) is a very effective and life-saving drug, but its toxicity profile has always complicated its use. Newer lipid formulations of amphotericin B show comparable efficacy to its deoxycholate predecessor but with a significantly reduced adverse side effect profile. Thus, amBd should probably be considered a second-line drug, except in a few specific cases, such as cryptococcal meningitis. Future work will focus on refining dosing regimens for these lipid formulations. Other new developments making the old polyene obsolete include the newer, extended-spectrum triazoles and echinocandins. However, despite the positive safety and efficacy profile of these new agents, mortality rates for invasive mycoses still remain unacceptably high. This article discusses developments in the major areas of treatment strategies to overcome refractory infections, which include rapid and accurate diagnosis; use of immune modulators; drug formulation and dosing; empiric, preemptive, and prophylactic strategies; and combination therapy, as well as new strategies for candidiasis, aspergillosis, and zygomycosis.
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