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Summary: future directions in antifungal therapy.
1Harvard Medical School, Transplant Infectious Diseases and Compromised Host Program, Infectious Disease Division and Transplant Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. jfishman@partners.org
Summary
Strategies for preventing and treating invasive fungal infections are reviewed. Delays in diagnosis and susceptibility testing hinder optimal antifungal therapy, necessitating combination treatments for better outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Invasive fungal infections (IFIs) pose a significant threat, particularly in immunocompromised patients.
- Current diagnostic methods for IFIs, relying on histopathology and slow culture growth, cause treatment delays.
- Antimicrobial susceptibility testing for fungi lacks rapid and standardized protocols, complicating treatment selection.
Purpose of the Study:
- To review current strategies for the prevention and treatment of invasive fungal infections.
- To highlight challenges in diagnosis and susceptibility testing that impede optimal antifungal therapy.
- To explore the potential of combination antifungal agents for improved treatment efficacy.
Main Methods:
- Literature review of strategies for prevention and treatment of invasive fungal infections.
- Analysis of diagnostic delays and their impact on antifungal agent deployment.
- Evaluation of the role of antimicrobial susceptibility testing in managing fungal infections.
- Discussion of preclinical and clinical trial approaches for novel antifungal therapies.
Main Results:
- Diagnostic delays, due to reliance on histopathology and slow culture identification, impede timely antifungal treatment.
- Lack of rapid and standardized antifungal susceptibility testing is a major obstacle to effective management.
- Combination antifungal therapy is proposed to accelerate clinical response, reduce toxicity, and improve pharmacokinetic profiles.
- Preclinical studies and clinical trials are underway to identify candidate therapies for IFIs in transplantation.
Conclusions:
- Optimizing the use of antifungal agents requires overcoming diagnostic and susceptibility testing hurdles.
- Combination antifungal therapies show promise for enhanced efficacy, reduced toxicity, and targeted treatment of IFIs.
- Further research, including preclinical and clinical trials, is crucial for developing effective therapies for invasive fungal infections, especially in transplant recipients.