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Duration of antifungal treatment in mold infection: when is enough?

Vera Portillo1, Dionysios Neofytos

  • 1Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland.

Current Opinion in Infectious Diseases
|September 20, 2023
PubMed
Abstract

Insights

Defining the optimal duration for antifungal treatment of invasive mold infections (IMI) is challenging due to poorly understood resolution criteria. Evidence is needed to guide decisions on stopping treatment in immunocompromised patients.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Invasive mold infections (IMI) are serious complications in immunocompromised individuals.
  • Current guidelines lack precise definitions for treatment cessation, relying on clinical/radiological resolution and immune recovery.
  • Existing data suggest prolonged treatment durations, often blurring the line with secondary prophylaxis.

Approach:

  • Review of current guidelines and available real-life data on IMI treatment duration.
  • Analysis of the challenges in defining treatment response and immune reconstitution.
  • Identification of the need for evidence-based algorithms for treatment de-escalation.

Key Points:

  • Optimal duration for antifungal therapy in IMI remains undefined.
  • Definitions for clinical/radiological resolution and immune recovery are scarce.
  • Distinguishing prolonged treatment from secondary prophylaxis requires clear definitions.

Conclusions:

  • Decisions to stop antifungal treatment for IMI are based on limited evidence and expert opinion.
  • More research is essential to establish optimal treatment durations.
  • Development of practical algorithms is crucial for guiding clinicians in IMI management.

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