Clinical practice: combination antifungal therapy for mold infections: much ado about nothing?

Area of Science:

• Mycology
• Infectious Diseases
• Pharmacology

Background:

• Systemic fungal infections have high mortality rates, with little improvement over the last decade despite increased antifungal availability.
• Current treatment strategies may be insufficient to overcome the challenges posed by invasive fungal infections.

Purpose of the Study:

• To explore the potential of combination antifungal therapy to reduce mortality rates in systemic fungal infections.
• To review existing evidence on the efficacy and safety of combined antifungal agents.

Main Methods:

• Review of in vitro and animal studies evaluating various antifungal combinations.
• Analysis of reported synergistic, additive, and antagonistic activities of different antifungal drug pairings.

Main Results:

• In vitro and animal studies suggest that some antifungal combinations exhibit synergistic or additive effects against various fungal genera.
• Conversely, certain combinations have demonstrated antagonistic activity, highlighting the need for careful selection.

Conclusions:

• Combination antifungal therapy presents a potential strategy to improve outcomes for systemic fungal infections.
• Further well-controlled clinical trials are essential to identify optimal, safe, and cost-effective antifungal combinations and to evaluate their adverse event profiles.