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Optimal use of existing and new antifungal drugs
1Department of Infectious Diseases & Microbiology, Faculty of Medicine, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. t.rogers@ic.ac.uk
Abstract:
Clinicians are increasingly aware that fungal pathogens are a significant cause of morbidity and mortality in hospitalized patients. Historically, these infections occurred in severely immunocompromised patients who were undergoing treatment for hematological malignancy or solid organ transplantation. Currently, however, systemic fungal infections are commonly seen in debilitated patients who are being nursed in intensive care or high-dependency units. These infections are mostly caused by Candida albicans but there is a growing proportion of strains of non- albicans Candida spp, some with reduced susceptibility to commonly used antifungals. The limited armamentarium of antifungal agents to date has meant that amphotericin B continues to be considered the most effective therapeutic agent albeit with a poor record of treatment-limiting side effects. The past decade has seen some encouraging developments in antifungal therapy. Three lipid formulations of amphotericin B showing reduced toxicity compared with the desoxycholate formulation are now licensed. There are three investigational triazoles currently undergoing evaluation that should prove important additions to existing members of this class. The echinocandin caspofungin is the first of a new class of antifungal agents with a novel mode of action, which has recently been approved for use in the United States.
Insights
Systemic fungal infections are a growing concern in hospitalized patients, particularly in intensive care units. New antifungal therapies, including lipid formulations of amphotericin B and novel agents like caspofungin, offer improved treatment options.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Fungal infections cause significant morbidity and mortality in hospitalized patients.
- Infections are increasingly seen in debilitated intensive care unit (ICU) patients, not just the severely immunocompromised.
- Candida albicans remains common, but non-albicans Candida species with reduced antifungal susceptibility are emerging.
Purpose of the Study:
- To review the evolving landscape of systemic fungal infections in hospitalized patients.
- To discuss the current therapeutic options and their limitations.
- To highlight recent advancements in antifungal drug development.
Main Methods:
- Literature review of clinical trends in fungal infections.
- Analysis of current and emerging antifungal agents.
- Discussion of treatment strategies for invasive candidiasis.
Main Results:
- Amphotericin B remains a cornerstone, but lipid formulations offer reduced toxicity.
- Newer antifungal classes, such as echinocandins (e.g., caspofungin), provide novel mechanisms of action.
- Investigational triazoles show promise for expanding treatment options.
Conclusions:
- The management of systemic fungal infections requires awareness of changing pathogen prevalence and susceptibility.
- Advancements in antifungal therapy are crucial for improving patient outcomes.
- New agents like caspofungin represent significant progress in combating invasive fungal infections.