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Update on antifungal treatment of invasive Candida and Aspergillus infections
1Department of Hematology and Oncology, Campus Virchow-Klinikum, Charité University Hospital, Humboldt University, Berlin, Germany. georg.maschmeyer@charité.de
Abstract:
Invasive Candida and Aspergillus infections are among the most common serious complications occurring in chronically immunosuppressed patients, in particular those with hematological malignancies and transplant recipients. A rational, early systemic antifungal treatment can be based upon imaging diagnostic techniques as well as upon conventional mycological and non-culture-based procedures. The availability of well tolerable and highly efficacious systemic antifungals has improved the spectrum of therapeutic options and the success rates of antifungal treatment. However, with respect to high treatment costs associated with these new agents, it is mandatory to specify indications and limitations for the use of these substances. Voriconazole may well become the new standard primary treatment of invasive aspergillosis. The role of the new echinocandins such as caspofungin, which has recently been approved for salvage treatment of resistant and refractory Aspergillus infections, in primary or combination treatment of invasive aspergillosis must be further studied. Caspofungin is at least as effective as, yet significantly better tolerated than amphotericin B for primary treatment of invasive candidosis in non-neutropenic patients, and has been approved for this indication. The selection of systemic antifungals in patients with invasive Candida infection critically depends upon the identification of Candida species involved, because some non-albicans Candida spp. are resistant to azole antifungals.
Insights
New antifungals offer improved treatment for invasive fungal infections in immunocompromised patients. Careful selection based on species and resistance is crucial for effective therapy, especially with agents like voriconazole and caspofungin.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pharmacology
Background:
- Invasive Candida and Aspergillus infections are significant complications in immunocompromised individuals, particularly those with hematological malignancies and transplant recipients.
- Early diagnosis and treatment are essential for managing these serious fungal infections.
Purpose of the Study:
- To review current therapeutic options for invasive fungal infections.
- To discuss the role of new systemic antifungals, including voriconazole and echinocandins, in treating invasive aspergillosis and candidosis.
- To highlight the importance of species identification for guiding antifungal selection in Candida infections.
Main Methods:
- Review of current literature on systemic antifungal agents.
- Analysis of clinical data regarding the efficacy and tolerability of voriconazole and caspofungin.
- Discussion of diagnostic and mycological procedures for early detection.
Main Results:
- Voriconazole shows promise as a standard primary treatment for invasive aspergillosis.
- Caspofungin is effective and better tolerated than amphotericin B for invasive candidosis in non-neutropenic patients and is approved for salvage therapy in Aspergillus infections.
- Species identification is critical for treating invasive Candida infections due to azole resistance in some non-albicans species.
Conclusions:
- Newer systemic antifungals have expanded therapeutic options for invasive fungal infections.
- Optimizing the use of these agents requires careful consideration of indications, limitations, and patient-specific factors.
- Further research is needed to define the role of echinocandins in primary or combination therapy for invasive aspergillosis.
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