Conventional Antifungals for Invasive Infections Delivered by Unconventional Methods; Aerosols, Irrigants, Directed...

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Conventional systemic antifungal administration can lead to toxicities and drug interactions.
• Unapproved formulations and administration routes are explored to optimize drug exposure.
• Data on these alternative methods are primarily from uncontrolled case reports.

Purpose of the Study:

• To review and update existing data on unapproved antifungal formulations and administration routes.
• To assess the application of recent data within current guidelines for invasive fungal infections.
• To highlight specific examples, such as amphotericin B aerosols for mold infection prevention.

Main Methods:

• Literature review of existing data on alternative antifungal administration.
• Analysis of case reports and available prevention/treatment guidelines.
• Focus on specific antifungal agents and dosage forms, including aerosols.

Main Results:

• Unapproved routes (aerosol, injection, topical, etc.) are used for antifungals to improve outcomes.
• Attribution of efficacy and tolerability in these cases is often challenging.
• Amphotericin B aerosols are frequently reported for preventing invasive mold infections, especially Aspergillus.

Conclusions:

• Alternative antifungal administration routes are utilized, particularly for refractory infections.
• Further controlled studies are needed to establish definitive efficacy and safety.
• Amphotericin B aerosols represent a notable area of investigation for invasive mold infection prophylaxis.