[Controversy concerning optimal prophylaxis and empirical antifungal therapy in immunocompromised patients]

This article presents actual major problem about a steady increase in frequency of opportunistic invasive fungal infections (IFIs) in immunocompromised patients. However, there still remains much uncertainty regarding the best methods for establishing the diagnosis of most IFIs. An international consensus, that defining opportunistic IFIs proposed three levels of probability: "proven", "probable", and "possible". Practising physicians approach this uncertainty by prophylaxis and antifungal empirical therapy. Unfortunately, up to now we dispose only few antifungals compounds and all have narrow of therapeutic windows. This article reviews the therapeutic options in chemoprevention and antifungal therapy. Fluconazole and itraconazole are the first durable alternatives to polyenes in chemoprophylaxis. However their use remains controversial as debate continues over both their effectiveness and their potential to select out resistant Candida sp. Amphotericin B is the "gold" standard for the treatment both empirical and proven IFIs, but this drug is frequently associated with severe nephrotoxicity. The lipid formulations of amphotericin B enable higher dosages to be administrated with lower incidences of side effects but its effectiveness is not sufficient. It is to be hoped that rationally designed clinical trials with the new compounds, such as for example echinocandins will lead to improved prevention and treatment of IFIs.