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Drug resistance in Cryptococcus neoformans
1Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, USA
Abstract:
Cryptococcus neoformans has become a major opportunistic fungal pathogen worldwide. Successful treatment of invasive disease with this fungus has used amphotericin B, flucytosine and various azoles. However, treatment failures continue to occur for a variety of reasons including direct antifungal drug resistance. Issues and mechanisms for antifungal drug resistance in Cryptococcus neoformans are reviewed. Furthermore, approaches and strategies for prevention and treatment of antifungal drug resistance are identified and these include host immune modulation, dose optimization, prophylaxis/empirical regimens, improved drug delivery systems such as lipid preparations of amphotericin B, surgery, combination antifungal treatments and development of new antifungal agents. Copyright 1999 Harcourt Publishers Ltd.
Insights
Antifungal drug resistance in Cryptococcus neoformans is a growing problem, leading to treatment failures. This review explores resistance mechanisms and strategies to overcome them, including new therapies and optimized drug delivery.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Cryptococcus neoformans is a significant global opportunistic fungal pathogen.
- Established treatments include amphotericin B, flucytosine, and azoles.
- Treatment failures are increasingly reported due to factors like antifungal drug resistance.
Purpose of the Study:
- To review the issues and mechanisms of antifungal drug resistance in Cryptococcus neoformans.
- To identify strategies for preventing and treating antifungal drug resistance.
Main Methods:
- Literature review of antifungal drug resistance in Cryptococcus neoformans.
- Analysis of current and emerging treatment approaches.
Main Results:
- Direct antifungal drug resistance is a key factor in treatment failures.
- Various mechanisms contribute to the development of resistance.
- Multiple strategies can be employed to combat resistance.
Conclusions:
- Addressing antifungal drug resistance in Cryptococcus neoformans is crucial for effective patient outcomes.
- A multifaceted approach combining immune modulation, optimized dosing, novel drug delivery, and new antifungal agents is necessary.
- Further research and development of new antifungal therapies are essential.