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Published on: March 22, 2012
Salvage Treatment for Invasive Aspergillosis and Mucormycosis: Challenges, Recommendations and Future Considerations
Matthias Egger1,2, Romuald Bellmann3, Robert Krause1,2
1Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Abstract:
Invasive mold diseases are devastating systemic infections which demand meticulous care in selection, dosing, and therapy monitoring of antifungal drugs. Various circumstances regarding PK/PD properties of the applied drug, resistance/tolerance of the causative pathogen or host intolerability can lead to failure of the initial antifungal therapy. This necessitates treatment adaption in the sense of switching antifungal drug class or potentially adding another drug for a combination therapy approach. In the current state of drastically limited options of antifungal drug classes adaption of therapy remains challenging. Current guidelines provide restricted recommendations only and emphasize individual approaches. However, novel antifungals, incorporating innovative mechanisms of action, show promising results in late stage clinical development. These will expand options for salvage therapy in the future potentially as monotherapy or in combination with conventional or other novel antifungals. We outline current recommendations for salvage therapy including PK/PD considerations as well as elucidate possible future treatment options for invasive aspergillosis and mucormycosis.
Insights
Salvage therapy for invasive mold diseases is challenging due to limited antifungal options. Novel antifungals in development offer future hope for combination or monotherapy treatments.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Invasive mold diseases require careful antifungal drug management.
- Treatment failure can occur due to drug properties, pathogen resistance, or host intolerance.
- Adapting antifungal therapy is challenging with limited drug classes.
Purpose of the Study:
- To outline current recommendations for salvage therapy in invasive mold diseases.
- To discuss pharmacokinetic/pharmacodynamic (PK/PD) considerations in antifungal therapy.
- To explore future treatment options for invasive aspergillosis and mucormycosis.
Main Methods:
- Review of current guidelines for invasive mold disease salvage therapy.
- Analysis of PK/PD properties influencing antifungal drug efficacy.
- Evaluation of emerging novel antifungal agents in clinical development.
Main Results:
- Current salvage therapy recommendations are limited and emphasize individualized approaches.
- PK/PD factors significantly impact antifungal treatment outcomes.
- Novel antifungals show promise for future salvage therapy, potentially in combination regimens.
Conclusions:
- Salvage therapy for invasive mold diseases remains complex due to therapeutic limitations.
- Future advancements with novel antifungals are expected to improve treatment strategies.
- Personalized approaches considering PK/PD and pathogen characteristics are crucial.
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