Broad spectrum triazoles for invasive mould infections in adults: Which drug and when?

Area of Science:

• Mycology
• Infectious Diseases
• Pharmacology

Background:

• Invasive mould infections (IMIs) pose a significant global health challenge, leading to increased morbidity and mortality.
• The rising population of immunocompromised individuals heightens the risk of these fungal infections.
• While broad-spectrum triazoles have improved survival, early diagnosis and treatment initiation remain critical but challenging.

Purpose of the Study:

• To review the role of triazoles in managing invasive mould infections.
• To highlight the importance of prophylaxis in high-risk patient groups.
• To compare the efficacy and spectrum of activity of posaconazole, voriconazole, and isavuconazole.

Main Methods:

• Literature review of antifungal agents for invasive mould infections.
• Analysis of clinical guidelines and trial data for triazole use.
• Comparative assessment of voriconazole, posaconazole, and isavuconazole.

Main Results:

• Posaconazole is recommended for prophylaxis in high-risk patients, including those with neutropenia or graft-versus-host disease.
• Voriconazole is primarily used for treating invasive aspergillosis, not prophylaxis.
• Isavuconazole is an alternative to voriconazole for invasive aspergillosis treatment; both it and posaconazole have broader mould activity and can treat mucormycosis.

Conclusions:

• Early diagnosis and treatment are crucial for invasive mould infection outcomes.
• Prophylaxis with mould-active triazoles like posaconazole is vital for immunocompromised patients.
• Posaconazole and isavuconazole offer broader antifungal spectra, making them valuable treatment options, especially for mucormycosis.