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Evolution of antifungals for invasive mold infections in immunocompromised hosts, then and now

Zoe Freeman Weiss1,2, Jessica Little3,4, Sarah Hammond4,5

  • 1Tufts Medical Center, Division of Infectious Diseases and Geographic Medicine, Boston, MA, USA.

Expert Review of Anti-Infective Therapy
|April 27, 2023
PubMed
Abstract

Insights

Novel antifungal agents are crucial for combating invasive mold infections (IMI) due to resistance and toxicity issues with current treatments. Further clinical trials are essential to evaluate new and existing antifungal therapies for better patient outcomes.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive mold infections (IMI) pose a significant threat, with current antifungal therapies facing challenges like toxicity, drug interactions, and emerging resistance.
  • Despite advancements over 50 years, there's a critical need for novel antifungal agents to manage the increasing prevalence of IMI and combat antifungal resistance.

Approach:

  • This review synthesizes the historical development and current status of commonly used antifungal agents for IMI.
  • It examines consensus guidelines, susceptibility testing, and the potential roles for novel antifungals in treating specific molds like Aspergillus, Mucor, and others.
  • The review critically assesses existing clinical trial data and identifies gaps in evidence.

Key Points:

  • Limited robust clinical trial data exists for the effectiveness of current antifungals against IMI beyond Aspergillus fumigatus.
  • Understanding the relationship between Minimum Inhibitory Concentrations (MICs) and clinical outcomes for existing agents requires further investigation.
  • Evaluating the in vitro and in vivo aspects of antifungal synergy is crucial for developing effective treatment strategies.

Conclusions:

  • There is an urgent need for well-designed clinical trials to guide the treatment of invasive mold infections.
  • International collaboration and standardized clinical endpoints are necessary to advance the field of antifungal therapy.
  • Novel antifungal agents and improved strategies for utilizing existing ones are essential to overcome treatment failures and resistance.
Keywords:
Antifungal therapyamphotericinaspergillosisechinocandinsfusariosismucormycosistriazoles

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